Tandem Diabetes Care, Inc. (TNDM) Earnings Call Transcript & Summary

Good morning. Why don't we get started? My name is Jeff Johnson. I'm the Senior Medical Technology Analyst at Baird and our next presentation this morning is from Tandem Diabetes Care, the manufacturer, the t:slim Control-IQ insulin pump that has gained 25% to 30% share of the U.S. insulin pump market here in recent years. I think I'm right on that -- my math anyway. Yes, maybe more. I knew you were going to bristle at that point. With us today from Tandem we're happy to have Chief Executive Officer, John Sheridan; and Chief Financial Officer, Leigh Vosseller. John, I'll turn it over to you, and then we'll move into Q&A.

Well, thanks, Jeff. Good morning, everybody. I'll just start off by saying that when you look at diabetes and specifically Type 1 diabetes in the U.S., it's a large and underpenetrated market. Today there's about 1.8 million people with Type 1 in the U.S., about 35% use pump therapy. When you look at the O-U.S. market, that's significantly larger. 25 countries we're in today, there's about 4 million people that have Type 1, and the penetration rates maybe 10% or 15% so a big opportunity there. Today, we have about 420,000 or 430,000 people worldwide using our technology. If you talk to endos or you talk -- we have the number one rated automated insulin delivery system on the market. And we also have, I think, the most exciting pipeline of new products in the works, 4 of which we'll be bringing to market here in the next few months and then a steady stream and cadence of new products over the next couple of years. So we're excited about where we're at. It's definitely a competitive marketplace, and we've experienced pressure from the competition in the last year. But I would say that as you look to this pipeline that we're bringing to market this year, in particular, we expect that we'll start to see that come back in our favor as we bring these markets -- these products to the market.

All right. Well, great. That's a good start. I'm tired of leading off with the GLP-1 questions. Can I go to something else and we'll come back -- maybe we'll come back. Exactly. We'll come back to it. I'm just I'm tired of talking about it. Type 1 penetration. It seems like we're probably right around 40% or so in pumps. I can remember a few years ago, that was moving maybe at best a point a year, and I was thinking, okay, maybe we get to 45%, 50% someday. You guys moved faster than I moved in kind of my expectations of where penetration would go. But it feels pretty convincing now that Type 1 penetration of AID should go, what, 65%, 70% over the next 3 to 5 years or at least 5 years?

That's what we believe. We think that in the U.S. can get to 65%, O-U.S., maybe 25%. And I think that it really is AID technology that's driving that. We think that the therapeutic benefits people experience from these new systems and the quality of life that they improve that the experiences will have a big -- is a big factor in driving that.

Yes. No. And I don't know that I've heard you use the 25% number before. It's rare that I'm more bullish than maybe you. But if you -- what do you think would limit it to -- again, the health outcomes even in international markets or not even in, but across the globe, the health markets of AIDs are so strong, and we hear even in international markets, KOLs there and that are just increasingly convinced that these T1s should be on AIDs. I mean there's nothing else that pushes your time and range up into those mid-70s and beyond at least at this point. So what do you think that would it be just pure or dollars the biggest impediment to the penetration above 25%?

It's possible to get there. I guess I was just thinking in the next couple of years -- it's a large number -- it's a large number. I mean, it's again twice the size of what the U.S. market is. And so I think that getting to 25%, that's -- in terms of just the absolute value of the new people. We certainly think it can get there. There's no reason why it can't be any different -- there won't be any different than the U.S. And I think that when you look at the various health organizations in the various countries, like NICE, for instance, they're sponsoring and actually promoting the use of AID. And I think that as people see the sort of the benefits to the health care system as well as the benefits financially to the countries that they will all do that.

Yes. And when NICE comes out and says cost-effective for [indiscernible], I mean, that's a big deal, right? So that was encouraging. Good. All right. Well, let's talk maybe about a couple of other things here. You refreshed your guidance on the second quarter call that was in early August. We're now sitting kind of 6 weeks out. We've seen Medtronic's Q1 numbers now. Maybe they're getting some improvement internationally for sure, U.S. still a little questionable. Beta has raised now $100 million here recently. Anything with the passage of time that makes you kind of reassess or you would add to kind of the guidance you issued just in August?

No. So I would say nothing from a competitive perspective is different than what we were anticipating as we came into the quarter. And really, the main basis behind the guidance change was thinking about the Mobi launch and the timing of it. So it was anticipating that with approval in July and full availability after the turn of the year, this could cause them quite a disruption as people are considering what to do when they're meeting their deductibles around this time during the year, and then they'll reset again GEN-1. So it was more about this -- the murkiness in the environment, I guess, as we try to understand what -- how our patients will behave in terms of the Mobi opportunity.

Yes. No, fair enough. And what are you seeing, I guess, at this point, to your point, Mobi's been out there since July. Let's start with maybe MDI and new patient starts. Does it cause any pause in new patient starts, I think you've got the potential that you could start on Control-IQ today and upgrade or move to sorry, start on X2 and move to Mobi if you want at a very low to no cost, right, early next year. So with that guarantee out there with that financial backing out there for you does that change new start dynamics in the near-term? And then I have a question -- a similar kind of question on kind of the renewals.

Yes. I'll talk through each of those because what we did when we looked at what we thought behaviors might be, we did break it down between what will someone who's never used a pump before do versus someone who's already on a t:slim. And frankly, for someone on a t:slim pump, it's actually easier to go ahead and purchase their X2 today and switch for that low cost, that $200 switching fee. That's our promotional pricing right now for Q3 and Q4. For someone that's brand new to pump therapy, though, that's the population that I fear might be most inclined to wait until next year. They're going to go through the calculus of I have the economic piece of it with how my insurance plan behaves, but that also means I have to learn at one pump today and turn around and learn a different pump in a matter of months. And so I think that's the population that's most at risk, what I would say, for deferral as we look forward in the next couple of quarters.

Okay. So you can help them offset the fear of having to buy one thing and then spend a lot on the other thing 6 months later, but you can't offset the why learn one, if I can just learn the other?

Precisely.

Okay. I got you. And then on the renewal side, any way to help us conceptually think about how many of your Control-IQ users are really all -- the vast majority of your users are Control-IQ, right, no legacy others. Okay. So how many of those Control-IQ users might be sitting out there with like a 4.5 or a 5-year-old pump for whatever reason they've just never upgraded. And now there's this chance that Mobi could pull them off the sidelines. Maybe it's more next year, but could still pull them off the sidelines when they otherwise might have just stuck with their t:slim?

Sure. So I think, first, a couple of important points here. So what could pull them off the sidelines? First really is the G7 integration. So thinking about that population, everyone's on G6 today probably eager to move to G7. And with that launch underway here and full availability in the coming weeks that could bring people off the sidelines already for an X2 purchase. And so that's one piece of it. But then I think our customers -- there will still be a high demand for t:slim X2. So it's not as if everyone is waiting for Mobi either. So there will be a population of people that prefer X2 over Mobi. And then the question is those people who prefer Mobi, what will they do? And so we believe there's still a significant opportunity there. We think the Tandem Choice program will really help alleviate some of the pausing in that population more so than the other. And I think what's important to you to point out is our renewal customers and our renewal trends have been the best that we've ever seen in the last 4, 6 quarters. So we're really excited about it. And if people choose to wait, that's fine too. We took that into consideration in our guidance change. But we're going to do everything to help them through the process as they think about the economic piece of it.

All right. Fair enough. And John, I think you were at Morgan Stanley, well, I think you both were. But a couple of day -- yesterday or the day before, whenever that was 2 days ago. What was my question going to be about Mobi and the timeline there? Oh, no, you talked about the G7 integration and still expecting it in 3Q. Now we're down to a couple of weeks in all that.

I'm mean, it's weeks away really from meaningful numbers of people on the system. I would say that it's -- since it's a software upgrade we have a great deal of experience working with Dexcom and sensors in general. It's going to be a rapid move from early availability to general availability.

Yes, because I think you have the letter out there to some on a trial.

Yes, we have a great deal of interest. I mean I would expect that general availability will -- I mean, we'll have thousands of people using it in a few weeks and general availability will be probably in the early part of Q4. That means that the pumps that we ship will have the software on it for G7. It also means that all of our current customers who are in warranty will get access to software upgrades so they can update their current pumps in the market.

Okay. Fair enough. That's helpful. And then I guess, I think about Leigh, in your 2023 guidance and kind of the back half implied there. There's a few different ways we could get to your updated guidance numbers. One thing we have in our model, I just wanted to cross check with you, as we talk about this potential slowing of renewals now as we get, then maybe it reaccelerates next year. Your renewals grew 40%, I think, year-over-year in the first half of this year. I've got that flowing all the way down to the low to mid-teens in the back half. Is that the dynamic of kind of pausing that you're talking about and is that a reasonable way to think about new starts still being down a little bit year-over-year and renewals, that growth rate slowing, but then still growing year-over-year?

Yes. I'll start with it is fair to assume that the growth rate could slow from first half to back half because of the pausing dynamic, not because of any other factor. We're not afraid of losing those patients but [indiscernible] yes, in particular. I would say the growth rate for the first half on renewals is actually a little bit higher than that. So is probably on the softer side. So I would anticipate our growth rate in the back half will be a little bit higher than what you just came up with. But relatively, I think that's fair.

Okay. So still to get to your full year number, and you've guided both U.S. and international and then I'd probably take that out of new starts to kind of offset stay within your guidance range. Okay. Okay. And then just, John, maybe on the timeline will be remind me how that phases in next year from a first half, second half standpoint when you kind of fully commercialize versus step that through the year?

Yes. We got approval in mid-July. And typically, after that happens, there's work you've got to do sort of clean up after the FDA has actually had access to the data. You have to update your manuals and things like that. We're now in the process of training our own sales force and our customer support organizations, who will go out and start to train healthcare providers and their staff. In a matter of weeks, we'll have hundreds of people on Mobi, and these will be friends and family and people close to the company. And the intent really at this point in time is just to get it out there and actually have it -- it's a brand-new pump platform. We want to make sure it works the way we expect it to. And so we want to look for customer service issues, maybe potentially training issues and things like that. And we'll do that for a few months. We want to make sure that before we really step on the gas, there aren't any issues out there that could kind of cause dissatisfaction or irritation amongst the customer base. And so I would -- we will start to do an aggressive commercial launch in the early part of the first quarter of 2024. But we want to get through this next phase here. I mean, as we gain confidence, we could move more aggressively. But I think from just a timing point of view, best to plan on early part of the first quarter.

Okay. And I think you've confirmed this before, but just rechecking it. Mobi pricing is probably going to be about the same as [indiscernible]. Yes. And then maybe, Leigh, for you, again, as Mobi drops the screen, manufacturing costs should come down, what, 10% to 15%, I think, relative to t:slim. How do those cost savings phase in because obviously, you're not going to have immediate full efficiencies on that as well? So how should we think about those 10% to 15% cost savings phasing in?

Yes. So what I told people to think about it is, think about getting to that over the course of 2024 so almost a year from initial launch to get to scale to start realizing the real benefit. Having said that, as we think about gross margin overall next year, I don't think it will be a significant headwind by any means. We have other efficiency opportunities even on t:slim we saw reimbursement opportunities to help offset some of that pressure we may see just from the higher cost, but we'll simply be because we're manufacturing at smaller volumes to begin with. And 2025, though, is when you'll start to see it really start to show itself in our gross margins, and it starts with the pump piece, to your point, with that lower manufacturing cost but then the consumables as well. The cartridge for Mobi has a greater than 20% reduction compared to t:slim. So as that becomes a bigger piece of supply sales in the future, you'll see that continued benefit over time.

Okay. Should all those numbers be about ballpark the same for [ Tobi ] as well as Mobi once [ Tobi ] if that comes out 2 months later or something? Okay. And I think you've talked about Mobi as helping contribute potentially as much as 500 basis points of the 10 points of expansion you expect over the next few years. Is there a percentage mix in there we should think about like Mobi has to get to 20%, 40% of your pump mix to kind of get that 500 basis points fully embedded?

Sure. So we haven't specifically shared the mix. But I think what I can highlight is we still have always assumed that t:slim will have meaningful share as well as Mobi. So you don't -- I guess the important thing is you don't have to assume Mobi as 75%, 80%-plus in order to achieve those margins. So even at a modest level of sales, we can still see significant margin improvement.

Okay. All right. And then if we look at the other kind of lever, so there's new starts, there's renewals and I guess, embedded within new starts there are competitive conversions. So I think through the timeline of you guys hit this fantastic window in 2020, 2021 when Control-IQ had just come out, that was like 4 years removed from when 670 had launched. So you had a ton of these Medtronic turnover, unhappy patients coming out and all that. But we're now kind of deeper past where 670 came out, and we're kind of more into a timeline where you guys have been taking massive share from Medtronic for a few years now. On that turnover piece or not turnover, but on the piece of patients -- on the number of patients coming out from competitors, does that number shrink over the next few years just on who's left on the competitive front for you guys to convert? And obviously, then you're battling maybe a little more aggressively than you had to a year ago against [ '05 ] for those turnover patients, but does just the size of that bucket narrow down?

It does. And we've always seen that in our modeling that, that would come to fruition. And really, our growth is predicated on our continued retention of our own customers, which is now a very sizable base and also the expansion of the MDI opportunity. And if you think about the new products we have coming out, we have 3 new products coming out that are going to drive that MDI opportunity for us. That's what's really going to make the difference going forward.

Okay. Fair enough. And then Yes. So it's probably been, what, 3 years straight, 4 years straight that you guys talked about 50% of your new U.S. patients are from MDI, 50% from competitive converts. And that has been -- I don't know every quarter for [indiscernible]

So as one has been growing the other has been growing at pace.

Yes. And so do we think that shifts then? Obviously, it seems like the math, but when do we start to see that go 60-40 MDI, 70-30? And how much of that could be driven by MDI numbers going up? It seems like the market is expanding faster than it has in the past for just total market size. So how much of that could be driven by MDI number going up versus that competitive number, just the opportunity is shrinking?

Yes. So it will begin to happen in 2024 is our expectation. But -- and for both reasons, I think the opportunity going down on one side and us improving on the other side. But I don't want to underestimate what Mobi can draw. While we believe it attracts a new segment of the market. I think it will be very appealing to people on other pumps today when they look at why they chose the pump they're on and what features it offers that are different, whether it's the size, the lack of a screen on it. So I think Mobi will still help us on that competitive conversion front.

Alright. Fair enough. And then let's see, let's, I guess, continue with the Mobi questions then. So I think at its peak, you guys were probably winning 50%, 60%, 50%, 55% of all MDI patients coming into the market. I think in the last few quarters maybe that slipped to 30-ish percent by our math, and we don't have everybody's numbers, but it seems like about that. Where do you think the MDI win rate? Does it go back up towards 50%? Can it get back to 50% with Mobi? Just where would you expect that MDI win rate to go?

Yes, it definitely will reverse course. And the question is how high will it go? And I wouldn't just tie that to Mobi to your point, I mean, the three new products. So we've got people picking G7 for the first time. So we expect [indiscernible] to continue to penetrate the market. That provides an opportunity for us as well. We have Mobi, which will attract a new segment of the market as we were just discussing, but we also have the Libre integration opportunity, which is almost greenfield territory for us when you think about estimates we've heard of 300,000 to 400,000 people with Type 1 already using that product. So with that integration in hand, that can also be a significant driver on the MDI side. So there's a lot of great things lining up to really push the needle for us. So I definitely think we can reverse course get back to where we were and ideally move beyond that.

Yes. All right. Fair enough. And then let me switch over to the international markets. I think most of our focus here has been on the U.S. But on the international side, I guess the question [ O-U.S. ] as well. But we've been hearing from a lot of our non-diabetes companies at this conference and others in the last couple of weeks about just summer seasonality. And this is obviously a summer of revenge travel and patients taking bigger and longer vacations, doctors doing the same. Anything to call out from a seasonality standpoint -- we tend to think of summer vacations more of a European type headwind to medtech, but anything to call out on a summer seasonality point?

We're not seeing anything out of the norm. I would say, to your point, in Europe, everyone tends to go quiet and usually see orders come in before or after as the distributors kind of manage their inventory levels. I mean, it's not to say we also see seasonality in the U.S. in the summer. It's a little bit softer around this timeframe, but again, nothing different from what we've seen in years past.

Okay. That's helpful. And then you guys just recently got positive reimbursement decision in France. What does that exactly mean for your business there? Is it simply just an increase in the ASP or the reimbursement, I guess, that you get for Control-IQ in that market? Does it open up any additional segment of the T1 patient base? France is, along with a couple of markets over there, always hard for me to understand their different reimbursement tiers and levels?

Yes, very convoluted in many cases. But I'll say first what it does it does increase the reimbursement for Control-IQ. But I think the most important point of it is considering France is not a significant piece of our total worldwide business, but it's a sign that this can happen. So it's our initiative to continue to improve price worldwide, whether it's in the U.S. markets using the value of our data. So when we talk to payers here, when we go to the social systems, we talked about inroads we're making with -- in the U.K. with a nice organization. So I think the most important point of this is it's a symbol that it can happen and that we're working hard to get it done.

Okay. And I think this is -- in 2024, it's going to be probably the first year that you're really moving into that 4-year turnover period in the international market where you have a decent number. Now, I think a lot of those were back-end loaded in 2019 or 2018 or '19, yes, in 2019. So maybe it's more of a second half '24 but should we start to see a bigger contribution from renewals in your international number, especially as we work deeper into next year?

Yes, it will start to become something more material. So the thing I caution about how to think about the renewal cycle outside the U.S., it's still a 4-year cycle and we're just beginning. But in the U.S., I've always said, take the warranty expiration and think about getting to a 70% retention rate in 12 to 18 months from that timeframe. Outside the U.S., the pumps have sat on shelves longer before they got put on patients. So I would add 3 to 6 months to that just because of that timing. And so yes, it will -- we're lapping the 4-year mark, and it will begin next year, but I don't think it will be as meaningful as you -- maybe the way people are modeling the U.S. today.

Okay. And I just conceptually think about the way we track our international numbers. So when I -- we take kind of a blend over 12 months getting towards that 70%, like you said, but I should probably do that on my, yes, I know conceptually what I'm thinking, even though it's not coming through on the question. Basically, I should wait 6 to 9 months before I start picking up those.

Yes, I think that's fair.

Still do the 12-month blend towards 70%, but wait [indiscernible] quarters. Yes, yes. Okay. That makes sense. John, maybe a bigger strategic question for you. You're in 25 markets around the globe, Medtronics in over 100. Are there any new market entries that would be worthwhile to consider here in the short run? Is it really head down focusing on your current 25 and obviously, the full pipeline like you're talking about for now, just how to think about maybe geographic expansion.

Yes. I think right now, you're right. Our focus is to get these new technologies into the O-U.S. markets for sure. And when you look at it, of the markets that we're in Germany, France and the UK really do represent the largest opportunity for us, we're just getting started on all those markets. And so I think that in the short term, our priority really will be to really penetrate those particular markets. We're certainly evaluating others -- most of them are smaller, I'd say. We don't have the same infrastructure that some of the competitors have. And so I think that the other thing to consider as well is at some point, we may about be looking at some of the Asian markets as opportunities although there are some challenges, I think, from a regulatory and timing point of view. But certainly, in the short term, we'll be really focused on those three markets I just mentioned.

Okay. If you were to expand into Asia, is that a 2 to 3, 3 to 5 year.

It's probably 2 to 3, I'd say before we were ready. I think that having the product now controlled by a mobile phone gives us a little bit more of an advantage because it's easier to get the -- this characteristic language address in that manner that [indiscernible].

All right. And then I know between Mobi and SIgi there's a number of algo improvements. There's [ Tobi ]. There's some other things in there. But I think SIgi next big after Mobi, at least my view, and maybe that's the wrong way to think about it. But you're supposed to go to first in human I think fourth quarter of this year. Is that still the plan for SIgi? And then what happens after that human pilot or that first pilot in man, if everything goes as planned, how many more studies beyond that, how many more trials and kind of think about -- help us think about the timeline to get to a full pivotal.

It's a new pump platform, so we want to test it. And so this will be first in-human for the system. It's a small study that will be run in Europe in the fourth quarter. I think that's just sort of the cautious safe approach to make sure the system is working correctly. We are just now engaging with the team. We've really only acquired the company 6 months ago. So we're in the process of really working -- helping them build out the organization and develop the detailed plans that are predictable to get this product to market. When it comes to any other studies beyond that, it's going to be submitted as an ACE pump. And as an ACE pump, it's going to be interoperable. And so we intend to load control like you want it and integrate it with other iCGMs. And so there's no regulatory requirement for us to do any additional clinical studies, although we probably will, that it will be smaller scale just for us to test things out. So at this point in time, there's a few technical issues that we are just working to confirm with the organization there. These are things that we believe that it's this -- we want to tend to show us that we can get these things done. We feel very confident that they can. And then in parallel, we're just putting our head down, getting the schedules in place. And I think that the big lift for us is to integrate the algorithm and the sensor compatibility with that system. And we think it's going to be a very differentiated and competitive advice when it does come to market in several years.

Okay. And then if there's not a major pivotal and I can't do what I usually do, we just think about how much you wear it for 3 months, it takes 6 months to get everybody enrolled and it sits at the FDA for 6 months. So if I can't go to that kind of historical timeline that used to always do a pretty good job of predicting timelines in this industry. Is mid-2027 still kind of the right time?

I think we're looking at '26, '27.

'26. What would have to happen to pull it into '26 as opposed to '27?

I mean I think it's a little bit early for us to say since we're just kind of getting things started. But I can tell you that when you look at the priorities in the organization today, Mobi 2, we think it's an important product. We think that the ability to go tube and tubeless in the same small form factor is important. So that's a huge priority for us as well as SIgi. And so I think that the organization really has heads down, getting those things going. And then we also have work that we're doing to enhance and improve the algorithms.

Yes. Okay. And then on [ study ] set, that's the 7-day infusion set. I know Leigh, I think that also plays a role in your 55% to 65% kind of gross margin progression here over the next few years. The pivotal for that is later this year, is that?

Yes, we're going to start the pivotal in the fourth quarter. It will probably take us 9 months to get through it and then on top of that, the filing. So we're probably looking at an available device in the early part of 2025. We haven't said specifically, but I'd say that's probably not too far off.

Yes. And Medtronic, I think got their 7-day approval in Europe. If I don't remember in the U.S., if they have it, now, I should know that. But we haven't heard them talk a whole lot about it. Obviously, they've got a lot of noise around their diabetes business, maybe it just hasn't filtered up to that discussion, but still think 7-day infusion can be a competitive advantage relative to others.

I don't think it drives pump decision-making, but it certainly is a customer satisfaction improvement. And I think people really are asking for it. It's also -- I mean, the technology that we've got in Capillary Biomedical can be applied to other -- it can be applied to Mobi Tubeless, for instance, and SIgi as well so that we can look at that slid that's going to be attached to the body as being an extended where it led as well. So I think that there's a lot of things we can do with it. As you just said, we definitely expect to see some gross margin benefits from it. But primarily, we're doing this because of the customer experience improvement.

Okay. And then in the last 2 minutes we have, I think Tandem Source, it seemed like there was a lot of excitement from your own people at ADA. I think from some of the docs we talk to as well, help me understand how Tandem Source relative to like Dexcom's Clarity. Do doctors would they use both Tandem Source and Clarity is they're kind of evaluating patients during those follow-up visits or would the expectation be that Tandem Source could replace Clarity? That was the one thing I still was a little confused on when I left ADA.

Yes. I think the difference is that Tandem Source has all of the data on it. We have the insulin data. We have the blood sugar data -- we have just how often you use it, how often it delivers bolus. So all of the information that's there is available on Tandem Source. And so we'd anticipate that if a physician was managing the diabetes for their patient population that they'd be able to do that effectively through Source. But Source also brings a number of other benefits to the company. It allows us to have a one-stop shop, not only for physicians but for patients. And I think that what we're looking at really with Source is to develop more of a consumer-like experience when people interact with the company so that you can purchase supplies online, you can basically find out exactly where they are, not unlike what you get from Amazon or just those sorts of experiences. And I think that it could be a source of training, it could be a source of customer service, all of the issues that you currently need to interact with the company can be available in this one site.

So more about -- or not necessarily more, but definitely a patient angle when they're not in the doctor's office [indiscernible].

I mean, this is really -- I think it's important to say that the physician is viewed as a very important customer of ours. And so this product really is intended to meet the needs that they've got.

Okay. And last one, 15 seconds. So I'll just throw out there is just Libre 2 integration, I think you said in the U.S. later this year in the fourth quarter. What takes you from Libre 2 to Libre 3? What has to happen to go from [indiscernible]

It's pretty -- it's a big lift. It's another -- it's an entirely different sensor. And so I think we were surprised by the approval of about 2 and 3 at the same time. We've been working on 2, obviously. So we're going to get to the market here in the fourth quarter. Again, we will be moving as quickly as we can. It will be available in the fourth quarter. And it won't be -- it will be sometime in 2024 really before I think it's available as Libre 3. And when we go to -- when we bring the Libre products to the European countries or to the O-U.S. countries, it will be Libre 3 through to start.

It will be. And just timeline on that.

We haven't said specifically, but I'd anticipate sometime in 2024.

In 2024. Okay. Well, with that, I think our time is up. So thank you so much for your time John. And as a reminder, next presentation is set to begin at 12:15 PM Eastern Time include Biohaven, American Well; and NIAXO.