DexCom, Inc. (DXCM) Earnings Call Transcript & Summary

Hey, good morning, everyone. Thanks for joining us. My name is Margaret Kaczor, and I am the research analyst here at William Blair & Company who covers DexCom. Now before we begin, I am required to inform you that I personally own shares of DexCom. But beyond that, you can obtain a complete list of research disclosures or potential conflicts of interest at williamblair.com. I'll do a short introduction then we'll kind of drive over to Q&A. But DexCom has been one of the top-performing stocks on our coverage universe over the last -- now 3 years probably. And despite the years of strong growth, sales continue to accelerate in spite of competition, pricing and tough comps. The impact of the pandemic is a little uncertain. We'll talk about that. But ultimately, as we look at the stock, the story from here is, where does diabetes management go over the next 3 years? Over the next 5 years? How important is innovation and access and data? And from our perspective, DexCom has been incredibly active on this front, probably more so than they frankly let on, and that the ROI of these investments is still largely in front of us. So we continue to believe this is a story with a multiyear opportunity in front of it. We continue to like it. But as you can tell, we've got Steve Pacelli, EVP of Strategy and Corporate Development; and Jereme Sylvain, VP of Finance and CAO at DexCom. It's a virtual conference, so we've moved to a fireside chat style discussion. But feel free to submit questions online, and we'll, of course, try to ask them as best as we can. But maybe let's just -- let's hit it off and start with COVID.

You guys -- your business is pretty resilient. You've got a lot of recurring sales, should put you in a pretty good position of stability and growth, potentially even through COVID. But as you look at the next 6 or 9 months of the pandemic, what are the largest risks and opportunities for you all?

Yes. I mean -- I'll start, and Jereme can jump in. I think certainly, unemployment. We got some good unemployment data came in just yesterday or late last week. But continued unemployment, we know, as you've seen this company grow over the years that access to reimbursement, if people lose their jobs and lose the ability to have product paid for, could be damaging. We haven't seen a meaningful drop-off. We talked about that on our Q1 call. There were some analyst notes that came out shortly before the call suggesting that new patient starts around diabetes technologies were down 50-plus percent. We haven't seen that, certainly. Patients are still able to get the product, their -- whether it's through Medicare and through their commercial insurance. We've actually brought on a number of states on the Medicaid side. It's a little bit kludgy still on the Medicaid side. But by and large, people are continuing to get access to the product. And as you've seen, really the sort of disheartening piece of COVID is that people with diabetes are dying at a disproportionately alarming rate. And so the need for this technology has never been more clear, be it on the consumer side or even as we start to push into the hospital during the COVID crisis.

Yes. It's an interesting time, right? Because coming out of Q1, we had very good patient growth. And so that just goes to show you that the interest in the product is still incredibly high and has been growing -- momentum has been growing over time. So when you think about that, the momentum and awareness continues to grow. Steve's right, unemployment -- a good portion of our business is reimbursed in the U.S. commercial coverage market. And as folks lose their jobs, and that's something that we're concerned about, how does it translate into reimbursement? So that's a big piece. The other piece is just how quick we can get doctors and nephrologists, PCPs up on telemedicine. And that's really around the new patient starts and how do we get folks into the doctor's office. In the U.S., our product still requires prescription, which requires then, obviously, a doctor's visit. And so I think those are the 2 headwinds we're ultimately facing, which we naturally are going to have to deal with it. It's why we went through guidance as we ultimately see what the post-COVID world comes to bring. But I would bring it back to the fact that we did come out of an incredibly strong Q1 with patient adds, and so I think the big issue is more of the uncertainty around how to get access, not that people still want access, not that it's still interesting. And curiously, as more and more folks move to a telemedicine platform more longer term, we think it bodes well for our product longer term. And so really, these are more temporary short-term issues over the next 6, 9 months as we deal with COVID. Over the long haul, we do think there's interesting tailwinds associated with remote monitoring.

And we were fortunately well positioned even prior to COVID, right, with our Share and Follow system with our CLARITY software to allow physicians. And actually, as a result of COVID, the FDA allowed us to actually open a more real-time access for clinicians to see their patients in real time. So it's not to say that this has been a good thing for us, but it's -- the company is still obviously doing quite well.

So if we look at kind of your comments -- granted you haven't given us specifics, but then we look at some of the pump companies that are estimating 50% to 75% declines in new patients in Q2 and then improving from there. Is there a disconnect that you're seeing then relative to what you're seeing and the CGM is easier to get trained on? Or...

Yes, it's a good question. What -- we basically have said, we've seen the doomsday reports, and I think we made sure we got it in front of our earnings call. We haven't seen a 50% decline in new patients. And then it just has -- our company hasn't seen that sort of new patient decline. Now your point is very valid, more than 70% of folks who start on CGM are self-trained. And so the physician doesn't necessarily need to be there. They're using online help or the intuitiveness of the product. So I think that bodes well for CGM starts in a period where you can't go into the doctor's office. And I think maybe some of the pump companies are seeing some of that. I can tell you, at least as it pertains to CGM and our business, we just haven't seen those levels of declines. Certainly, it hasn't been the same new patient environment as it was pre-COVID, but we aren't seeing the declines they're seeing. And I think a lot of it has to do with the nature of our product.

Okay. That's helpful. And then the other thing was right after your earnings call, I think CMS had announced easing some of the requirements for Medicare patients. What's going to change? And can that be meaningful to near-term growth goal?

Yes. I mean we've taken a very conservative read on that CMS kind of expansion. A liberal read could suggest that anybody who wanted access during the COVID crisis can get it. We've been a little more clear that we think it means that if you have COVID, if you contract the virus and you have diabetes, not necessarily just insulin-requiring diabetes, but kind of broadly speaking, that you could get access to the technology. I wouldn't say we've seen a meaningful uptick in new patient adoption as a result of that, though.

Yes. And the one thing I think it does bode well for and a lot of folks caught onto it and thought it might be a floodgate for all Medicare patients getting access to CGM without needing to meet the requirements that CMS has put in place. We haven't interpreted it that way. We worked with CMS, we have our consultants doing so. But the thought process around Medicare, recognizing that remote monitoring in these situations, regardless of whether or not you meet all of the criteria for type 1 or type 2 intensive is encouraging. And so we hope that, that translates over the longer haul to them to say, well, gee, monitoring diabetes remotely, especially for our elderly population is something that is beneficial, both for the patient and the clinician. We hope that's a start of things to come. But right now, it doesn't really open the floodgates because it is limited to COVID-afflicted patients.

And are you seeing any changes at either of the similar vein or otherwise for telehealth with private payers? Is the ongoing pandemic accelerating some of those movements and discussions?

It's hard to tell right now. And the reason why I say that is you've got 6,000 endocrinologists in the United States and some 250,000 primary care physicians. And a level of variability as to folks getting access to telemedicine compared to those that now have telemedicine are prescribing more, you're kind of balancing those 2 types of things out. And so we are hearing some anecdotally, some physicians saying, "Look, I -- boy, this is something that's incredibly helpful in monitoring remotely. And therefore, we're going to start prescribing this more often." Absolutely, anecdotally hearing that. Question is of those 6,000 endocrinologists, how many are up and running on telemedicine at the same levels as before to where you don't see the 2 kind of wash out? And that's when we get back to that bold comment. We haven't seen new patients starts back to where they were pre-COVID levels, albeit we do think the catalyst to more folks being on therapy in a new world of doctor visits is a good tailwind over the long [ haul ].

Yes. So maybe as we move beyond just COVID and shift into that core market that you guys are in, which is the type 1s. The data has been overwhelmingly positive for CGM as a category. You've got society guidelines or gold standards, you've got reimbursement coverage. Why are there patients still on the sidelines? And what can you guys do on a daily basis to get those patients to adopt CGM?

Yes. I mean as you know, it's an economic issue. Where there's reimbursement, you've seen the business -- even not just in the U.S., but where there's reimbursement in Europe. Germany is a great example and the explicit growth we've seen there, just on the heels of the government paying for it. So it really is an economic issue where if people don't have appropriate coverage, they may not get access to CGM. But outside of that, you're right. I would argue anyone in intensive insulin, whether they're type 1 or they're type 2s on MDI, over a relatively near-term period, I don't want to give an exact time line, but it should absolutely be the standard of care. People pricking their finger 4 to 6 to 8 times a day should be a thing of the past, we totally agree. It's just a function as we -- both in the U.S. and particularly outside of the U.S., it's incumbent upon us to continue to push for better and better coverage to get people access.

Yes, it's moving. I think the one thing that we talked about is UnitedHealthcare, historically, didn't cover type 2 intensives. And we had another large payer that's now covering type 2 intensives. And so when it comes to this economic conversation, it's lowering barriers to adoption. Certainly, that's about ease of use, convenience, providing accuracy, but also the reimbursement and lowering barriers to adoption there. And I think we're continuing to do that. I think that's indicative of what you saw at Q1 results with record new patients in Q1, which for DexCom, generally doesn't take place. Generally, it's -- in Q2 or Q4 is where you generally see those types of swings happen because of the nature of our U.S. self-payer system. So the momentum is there. And the education is there. And so I think we're making the progress. And it's -- again, it's that reimbursement conversations. We're very excited to have more and more reimbursement in the type 2 intensives. I think that will help continue to make that move and it's on us to continue to look at reimbursement and lowering barriers to adoption.

And so there's kind of 2 things we're talking about, right? We've got the intensive type 1s that maybe are kind of not quite at a full penetration. You've still got maybe half the market to go, right? But on the margin, you're kind of on a...

Yes. Yes. That's all outside the U.S.

Sorry, go ahead.

Yes. No, I mean, you're saying if -- we could be, as a category, close to 50% penetrated in type 1 in the U.S., that would be us together with Abbott and Medtronic. I don't know that it's really that high. But yes, there's at least half the market in type 1s to go in the U.S. And it's much less penetrated outside the U.S., even in type 1.

And so let's talk about the U.S. just for a split second from the type 1s. Yes, and let's say it's even 1/3 penetrated or 40% penetrated. Do you think a good number is 80% or 90%? And then are you still on that steep part of the curve? Or are you starting to increasingly rely on kind of those intensive type 2s starting to pick up some traction?

No, I think -- I mean, again, it's never going to be 100%. You have noncompliant patients. You have people who have type 1 diabetes who [ doses ] insulin without even checking their blood sugar, right? So you're never going to get 100%, but there's absolutely no reason -- when we think of kind of standard of care, I think of 80-plus percent penetration in the category. So there's no reason that it shouldn't get to north of 80% in the next several years. Again, predicated on access and access via insurance, access -- as we make access easier, not just the financial piece, but through the pharmacy and through some of the other channels we're working on to make it not just affordable but more accessible for the patient, they can go to their local Walgreens to pick up the product without having to go through the rigors of DME paperwork and processing. And so I think -- that's something that I think we're going to leverage -- we'll leverage COVID, right, where the need to have to go into the clinic to collect that documentation, just we can't do it today. So we're seeing some easing, I think. And that's kind of what CMS is -- part of their -- the update that we just talked about. We're using some of the documentation requirements, right? The prior policy required patients to visit or at least have contact with us every month to go into their doctor. Really, we jump to improve that they have diabetes like once a year. It's just pretty onerous stuff, right? And I think CMS has used that a little bit to the extent we can continue to push where we've been taking -- because of COVID, when patient visits aren't as accessible in person, neither the documentation -- the availability of the documentation does not support staff inside the clinics, et cetera, I think we're going to leverage that and push harder to get us into the pharmacy and ease some of those burdens.

Okay. And one of the questions that came in is just a little bit about utilization retention rates. Have those meaningfully changed over the last, let's call it, 2 years or so? Or pharmacy...

Yes. So they've gotten a little bit better as we've migrated to G6. And so what I'll call it -- we call it our [ ret ]. So when I say utilization, I'll break it down between utilization and retention. So retention has gotten a little bit better since the migration to G6. And so it's a little bit stickier on our product, Zero to no fingersticks and whatnot. In terms of utilization, utilization hasn't necessarily changed all that much in terms of how often patients are on therapy. There is -- there was a bit of a shift, they can move from G5 to G6 and having the automatic 10-day shutoff. That was inconsequential to the overall financial, so that really wasn't the issue. The bigger concern that we always have is about retention. When we talk about retention, it's trialing. There's also financial reasons to come off. We haven't seen any issues on retention. In fact, we've seen it get a little bit stickier over time.

Okay. Helpful. And then before we move on to kind of the type 2 section, international has been so much of a growth market for you guys. Another question we got was, "Understandably, Canada is not a primary market for you guys. But are you in the conversation with the Canadian government in regards to pay coverage, specifically within type 1s?"

Yes, we are. And there is some coverage for pediatric patients. But in all honesty, we've been quite successful with this direct-to-consumer model in Canada. And frankly, we're going to replicate that in some of the other markets outside the U.S., where you don't need a prescription. You can literally go on to the website, order product and have it shipped directly to your home. If we can make the product accessible for patients in that manner, I think we're going to continue. Canada has been -- and you say it's not a primary market, it has been -- it's not a big market, but it has been a very nice growth driver for us.

Yes. I was going to say, we are looking at giving -- so there's, I think, 1 or 2 providences that have public reimbursement at this point. The rest is private payers. And private payers predominantly have said, look, we think this is a good product. Those providences are starting to open up. And we're in line and we're having discussions with those providences around getting public reimbursement on top of private reimbursement. So that is an area, Steve's right. It's about a channel as well. And I think we're also seeing growth to our e-commerce channel.

And so maybe from a broader opportunity internationally, what are the moves that you guys have made? It used to be kind of a country-by-country thing where we would talk to you guys, and you referenced France or the U.K. or Germany. Is that still roughly how you're running your strategy out there? Or what are you guys doing to...

Yes. It's applying more resources where we have -- applying resources to obtain reimbursement. And then when reimbursement comes into being, then applying significantly greater resources in those markets. So we still -- we can get people reimbursed in the U.K. but there's still not a formal policy. We're still pushing hard there. France has been a tough one because they're willing to pay for it, they're just not going to pay enough, going to pay basically kind of a fingerstick level of reimbursement, and we're just not willing to do that. So we've -- while patients can pay cash and obtain a product, we're not pushing aggressively in France at this point because the reimbursement environment just doesn't work for us. Germany, as we mentioned, has been a great growth driver. The Nordics have been paying -- Sweden, for example, they've been paying for the product for a long time. And that market is actually pretty well penetrated at this point between us and Abbott and Medtronic. So we're going to continue to push. When we talked about Japan, we have G6 approved in Japan, but we didn't get -- the timing didn't wind up to get us established reimbursement for the G6 as a consumer product. So we'll have to wait probably at least until kind of the cycle next year or maybe hereafter. So Japan will be a slower growth engine for us. Our understanding is that Abbott does have some reimbursement in Japan but they were willing to take, again, basically discounted, almost fingerstick level of pricing and reimbursement. We just don't want to do that. And frankly, the key opinion leaders are the people who advise the government, and they've advised us not to do that. They're like, "You need to do this and do it right." And so that's the path we're going down to. There's no reason -- I mean if we were to accept what Abbott did now, there's a real possibility that we could never go back. And the advice we're getting is just don't do that. It may be a little slower out of the gate, but this is too important to do it the wrong way.

And so a lot of the questions -- we're getting a fair number of questions now online, so I'm going to try to go through a fair number of them. But a lot of them are focused on next-generation technology opportunities as well as kind of type 2 nonintensive. So I'm just going to start going through them. One of the questions was, "If type 2 nonintensives are a big, long-term opportunity, in what scenario can DexCom be #1 in this part of the market, given that Libre is cheaper potentially and these patients maybe need fewer bells and whistles? Or is it the expectation for you guys that you can be a strong #2 behind Abbott in the type 2 nonintensives?"

No, I don't think we would expect to be #2 in any market. There's a combination of things there, right? Gen 7 is a game changer for us in terms of flexibility as a product, but we're not going to wait to go to the type 2 nonintensive market until we have G7. We're going forward today, really more on a [ pilot -- this ] broader kind of pilot, clinical trial-type studies as opposed to just going direct. Right now, there just really isn't any meaningful reimbursement for the nonintensive patients to the extent Abbott's gaining some share there. They were doing it through some interesting buy-down programs and things. They're basically subsidizing it at the pharmacy level. That's something we've elected not to do at this point. We've elected to go in a little bit different path. And I mean you guys have all spoken to Matt Dolan, who runs the new markets group and type 2 nonintensive is squarely in the middle of that focus. We're going to do this on a number of fronts. We're going to look to some B2B-type opportunities where we're working with employers, working directly with the health care providers like Intermountain and UnitedHealthcare on to the -- some other group we're working with. And then we'll also look to, at the same time, how do we establish a kind of direct-to-consumer business there, just like the type 1 and intensive type 2 opportunity where we have to produce data to show that the payers are going to save money, our employers are going to save money in the long term from health care costs associated with diabetes before they're going to agree to quit all of their noninsulin-using type 2s on the product. And that's really the products of our efforts right now with United, with -- Livongo's working on a different project with Intermountain. You saw some small data set with Intermountain earlier this year, which was remarkable. The cost savings were incredible over just a 6-month period in patients using the device, without any coaching, without any additional feedbacks, using the product like it was designed, and that was with G6. And so Intermountain's working to expand -- pretty aggressively expand the scope of that study. The -- some of the unknowns are how long do -- does a type 2 that's not taking insulin, do they need to wear a product for 2 weeks, for a month, for 6 months? And I would argue that, particularly in that patient population, there's no one size fits all, right? If a patient comes into one of these programs with an A1c north of 10%, they're going to have a much different treatment protocol than someone who comes in with an A1c below 7% where we might capture some data and make -- the doctor might be able to make a couple of tweaks to their diet or the timing of their medications or something like that. But by and large, it's -- someone with an A1c below 7% has probably a reasonably good control of their diabetes versus the person who's not that we can make some significant changes. And that person's probably going to be on CGM for a more extended period of time to help get them back into control.

Yes. One thing I'd add to it is to say, it's 2 different go-to-market strategies. We believe in a partnership route. We believe that over time, reimbursement and outcomes and having remote monitoring, those bells and whistles are important ultimately to servicing this population. Abbott's taking a different view. It's a huge market. We'll see which goes -- which path is the best. I think both will be incredibly successful, we're just going at it a bit of a different way. And I think -- we obviously believe in our strategy and the way we're going after that population. We believe that if these payers are interested in this and they do turn it on, that's a great opportunity for us. It's a great opportunity to make sure you go to a population that now has insurance coverage, which is a lot different maybe than the way [ Abbott's client did ]. Both are interesting strategies, but again, we believe in ours.

And one of the other questions that have come in is sort of along that same vein as the business model. So when do you guys view that this diabetes management, as a whole, can become the fee for outcomes? Whether that's for you, whether that's for a specific manager, whoever else, when does that happen?

That is a good outcome [ to that ].

So I think it really depends on how do you define what that fee for outcomes will ultimately be and which payers are going to sign up for it. I think we've been happy to actually go into it.

We would love to.

Say with the Intermountain Healthcare study, if we can prove it saves $5,000 a year and you want to split it with us, that would be a pretty good answer for us. So we'll be -- we're happy to go into those fee arrangements, and we've approached it. I think the biggest part is it's really hard for these health systems to really quantify it and understand, well, what drove it? How is this? What would we share in? And I think that's the problem. But anybody that's a payer that's out there listening and wants to talk to us about it, we keep trying to knock down the doors, and we'll continue to keep going.

And one of the things, just from my time covering ESRD, which I know is a different market, is that they were trying to move to a bundle for the longest time and a value-based bundle for the longest time. And it's been like 7, 8, 9 years, and they're still working on it. Do you think it gives you less time, I guess?

The question is, is it through the payer necessarily? Or could it be through an employer, for example? Because really, larger, self-insured companies can actually recognize the benefit and act much more quickly than potentially a large payer. So Livongo is a good example, right, where they're really targeting a solution to the employer directly. And we'll participate there. So I don't know. I mean payers -- there are certain payers who do have a tremendous amount of data and really do understand the costs associated with this patient population. And there are others who would really struggle, I think, to figure out what's the appropriate outcome to measure. Like how are we going to get compensated for the "savings"? And then you start thinking about the real savings to these folks is over the longer term, with -- particularly with type 2. When you're thinking about delaying the onset of any product complications, then the cost savings there becomes enormous. Then the payer asked the question, naturally, "Well, are they going to still be part of my plan? Or are they going to be potentially on another plan or even on Medicare by the time that the complications manifest?" So these are all discussions that we're having. But at the end of the day, it's going to be the data that drives this. We're going to have to show that we save the system money. And that's what we're working hard to demonstrate with the various studies and pilots that you guys are aware of.

So that will be the clinical data, less technology-driven because a lot of the questions, even as they're coming in and say, thought process that G7 is what's going to start capitulating this and creating this churn in the space. But you're saying it's [ more ]?

I think G7 -- what G7 does is it gives us the flexibility. G7, that scale, gives us the flexibility from a financial perspective to get creative. G6 is a little bit harder because it has a reusable transmitter. So when you're providing a person with a G6 system, you're giving them 3 months' worth of life on a transmitter. With G7, it will be a couple of weeks' life. And so if there's this intermittent use scenario and maybe patients go on for a month and off for a month and then on, there's all these different scenarios that we're still working through with the payers. I think G7 provides us a lot better flexibility, plus the form factor is better. It's still a full-blown real-time CGM. It has all the features and functionality of G6 in a much more discrete, disposable form factor. So it's a great product.

And there's nothing in the technology that stopped G6. And G6 is already being used in these pilot programs. So we don't want to give folks the impression that we're not already going in with G6. But I think a lot of folks are rightfully focusing on G7 because as you get into the type 2 space, you start to get tuned to a consumeristic element. And the small form factor of the G7 really speaks to the consumer. It's smaller than Libre. It's much smaller than G6 and Libre, quite frankly. And so if you're wearing a nickel on your arm, that's a little bit different than wearing something that's a little bit bigger. That consumer element's helpful. The disposable nature is also helpful as well. And then having the ability for onetime usage and then manufacturing automated at scale provides the financial flexibility to make the decisions we make.

One of the other questions that came in is, "What's the risk of disruption through IT-based companies like Apple? You're obviously working with Verily. But anything else new for the folks that are targeting the area?"

In terms of technology, I mean, I think we've established that continuous sensing is critically important and doing it. I mean we hear all the time with people trying to -- there's a graveyard of companies who've tried various noninvasive technologies, and they've all failed. So I'm not worried about Apple shining a light through their watch and disrupting our business in that respect. Although the caveat to that would be potentially for some application outside of a true medical technology. So for anybody managing diabetes, you're going to need to have the performance and accuracy that our sensor provides. During -- looking at health and wellness and trying to monitor glucose as a metric as part of an overall health exercise diet and not necessarily a medical condition like type 2 diabetes. There may be some noninvasive technologies that might be kind of good enough. I think the FDA is going to be very cautious on those -- on approving those technologies where there's any risk that a patient could actually hurt themselves, whether it's dosing insulin or otherwise. I think the FDA will be right in the middle of that discussion. So no, I don't see -- we're partners. And we talk to all the big technology companies. We work with Verily, with Google. We've talked to Apple for years. Apple has been a great partner for us from just influencing activity perspective over the years as you guys have seen with the Share and Follow system. So no, I don't think there's risk of disruption. I think there's, frankly, good partnership opportunities across that landscape going forward.

And then maybe one more question since I think we're running low on the clock, but -- that -- I keep mentioning this every year, but 3 years ago, maybe 4 years ago, Kevin, we had him in our conference. He specifically made a prediction on type 1s. He's kind of right along with that in terms of penetration of type 1s and how fast the adoption has been. So I'm going to throw that to you guys.

What was his -- sorry. What was his -- remind me what his prediction was a few years ago, I don't remember that.

I think he had said at that time that within 3 years, you'd be close to 50% penetration in the CGM type 1 market. And within 5 years, he would be close to 80% penetration. Yes. So we'll see how...

Yes. Within the next few years, I think if -- again, it goes back to the simple formula. If it's paid for and patients have access to the technology, from an economic perspective and ease of access through the pharmacy, then I think 80% is reasonable. I don't want to tell you that it's next year or the year after, but it's certainly achievable in any of the reimbursed markets. There's no reason people should be pricking their finger anymore with the technologies that are available today.

What about the managed side?

What's that?

What about the type 2 intensively managed side?

So we're seeing great progress. The payers are -- like, Jereme said, with United adopting coverage at the beginning of April, there's very real recognition on the part of the payers. And I think COVID may have actually been an accelerant there where because people on insulin were getting sick and going to the hospital and not coming out of the hospital, I think there's recognition that this technology is meaningfully important to people. If you think about it, a type 2 who's on multiple daily injection therapy -- I mean these are folks who had diabetes typically for a longer period of time. They progressed from kind of diet, exercise to metformin to maybe some other compounds before they went on to insulin. So these are already, probably, somewhat compromised people anyway. And I think the payers are recognizing the need for the technology there.

Yes. I think the way to think about it just is it's a few -- it's a reimbursement conversation plus access. We believe the type 1 intensive is a very similar type 1s in terms of the need for CGM, but the reimbursement is a few years behind. And so if you think that the catalyst is reimbursement, it's going to take a few extra years to meet the type 1s as type 1s have been reimbursed for some time. And type 2 is going to take us some blocking.

Great. Well, any final comments from you guys?

No. I think we look forward to catching up with everybody on the one-on-ones over the next couple of days. And with that, we'll talk to you guys again after the next results.

We look forward to it. And thanks for the time for everybody out there today. Appreciate you jumping on with us. It's great to talk shop.

Appreciate it, guys. Thanks.

Thank you, Kaczor. Take care.