Tandem Diabetes at Barclays Conference: Strategic Caution Amid Growth

On Tuesday, 11 March 2025, Tandem Diabetes Care (NASDAQ: TNDM) addressed the Barclays 27th Annual Global Healthcare Conference, offering a strategic overview that balanced optimism from a robust 2024 with conservative guidance for 2025. The company highlighted strong past performance and future growth drivers, while also acknowledging market volatility and economic challenges impacting their outlook.

Key Takeaways

• Tandem achieved an 18% revenue growth in 2024, surpassing its initial guidance of 10%.
• The company plans to expand its sales force and enhance product offerings, including the Mobi infusion pump and Control IQ plus algorithm.
• 2025 guidance forecasts a 10-11% revenue growth, with a focus on profitability and improved EBITDA.
• Tandem is exploring opportunities in the Type 2 diabetes market, aiming to increase pump penetration beyond the current 5%.
• The company is transitioning to direct sales in select international markets by 2026.

Financial Results

• 2024 Performance:

- Revenue grew by 18%, surpassing the initial 10% growth guidance.

- Achieved double-digit growth in MDI conversions.

- EBITDA was negative 1%.

• 2025 Guidance:

- Revenue growth is projected at 10-11%.

- EBITDA is expected to improve to 3%.

- Guidance includes minimal credit for pharmacy or Type 2 diabetes market contributions.

• Margins:

- Focused on profitability and cost reduction strategies.

- Anticipated margin benefits from Mobi.

- R&D expenses to grow slower than revenue.

Operational Updates

• Product Launches:

- Successful launch of the Mobi infusion pump.

- Upcoming release of the Control IQ plus algorithm and Android compatibility for Mobi.

- Introduction of the Freestyle Libre 3 sensor.

• Sales Force:

- Expanded U.S. sales force equipped with data-driven tools.

- Direct sales transition planned for select international markets starting in 2026.

• Pharmacy Channel:

- Achieved 20% covered lives through the pharmacy channel.

- Pharmacy contracts structured like DME contracts.

Future Outlook

• Growth Drivers:

- Full year availability of Mobi with new features.

- European market expansion with Mobi pending CE Mark application.

- Opportunities in the Type 2 diabetes market.

• Type 2 Market:

- Planning a pilot program to refine market approach.

- Aiming to increase pump penetration beyond 5%.

- Addressing hurdles in government plans for pump coverage.

• Strategic Focus:

- Continued emphasis on profitability and cost management.

- Leveraging multichannel access for optimal financial outcomes.

Q&A Highlights

• Sales Force Expansion:

- Managed carefully to minimize disruption.

- Aimed at increasing market presence and reach.

• Pharmacy Benefits:

- Reduced out-of-pocket costs for patients.

- Improved access for both physicians and patients.

• Type 2 Market:

- Requires development and investment.

- Anticipates gradual demand increase.

In conclusion, Tandem Diabetes Care remains focused on strategic growth through innovation and market expansion, while cautiously navigating economic uncertainties. For a detailed account, refer to the full transcript.

Full transcript - Barclays 27th Annual Global Healthcare Conference:

Matt Mexic, Med Tech Analyst, Barclays: All right. Well, thanks everybody for joining us this afternoon. We’re very pleased to have with us again management team from Tandem Diabetes, John Sheridan, President and Chief Executive Officer as well as Katie Nikoletti. Katie, thank you very much.

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: Katie is our VP of IR. VP of IR.

Matt Mexic, Med Tech Analyst, Barclays: So my name is Matt Mexic, I cover med tech here at Barclays. Wanted to maybe start with one of the things that came out of first quarter or the fourth quarter call, was just around the way you described growth and guidance for the year, confidence in obviously the top line guide that you gave, which was 10 to 11, but then accounting for maybe some of the adjustments that you’re expecting around the alignment, right? So that’s maybe 11 or 13 adjustment for that. So maybe talk about how you arrived at that number and maybe to put it in context how your guidance generally has kind of changed in the last couple of years the way your philosophy behind guiding?

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: Yes, I mean first of all, I would say it really hasn’t changed. We still tend to be conservative. If there are things we can’t predict or have good sense on how they’re going to influence our guide, we typically don’t include them. And so therefore, we include things we feel comfortable we can speak about. So the confidence in our guide for 2025 is several factors.

I’d say the first one is largely the introduction of Mobi has been very successful for us. Smaller infusion pump is controlled by a mobile app. It’s been very well I mean, the people who are using it love it and it’s the uptake has been great. And so if you look at ’twenty four, we really didn’t introduce it until like the midyear when we got G7 integration. And so ’25 now represents a full year of Mobi.

In addition to Mobi, we have another a number of other great pipeline additions. In just a few weeks, we’re going to roll out Control IQ plus which is a new version of our algorithm. Our algorithm remains the best on the market and this is just an enhancement to it. We also have with Mobi, we’re going to add Android capability. Today, it’s just iOS.

We’re introducing the Freestyle Degree three, which is a very successful sensor that’s been introduced by Abbott, our partner. And we’ve also got we have filed for CE Mark for Mobi, which will enable us to get into the European markets. European markets are larger. We think Mobi is going to do quite well there. So a lot of things on pipeline as well that we’re excited about.

We have expanded our U. S. Sales force. We’ve also given them additional data driven tools to help the decision making process. So I think that’s a driver for us.

And we have successfully navigated the introduction of the pharmacy channel. I know we’ll talk about this in a moment. But I think certainly the access improvement that comes with that, the out of pocket reduction for the patients is really a big deal. And then finally, we just had our Type two indication approved and we think that represents an opportunity for us in ’twenty five also. Great.

There’s a lot of things going on.

Matt Mexic, Med Tech Analyst, Barclays: There are a lot of things. And that was my kind of reaction as well. And yet, I’ll answer part of this next question for you, which was the reaction of the stock was quite severe. And my answer to the question is, this is a market environment where any wrinkle or anything that makes folks nervous results in kind of an out side. Yes.

I’d kind of compare it to last summer there was a few names that Dexcom for example was one where there was a lot I’d say there was a lot more new and adjusted adjustments to guidance and so on. But still I think a lot of people look at that move and say, wow, that is a big move. There was a few others that were down a big number. So I think market volatility has a lot to do with it. But I have to ask the question like in the conversations you’ve had after the quarter, which one of these or what part of the story of rolling these things out Type two, which has been a big driver for the enthusiasm around insulin, for example, somehow just didn’t land or resonate with folks in the same way when you made your announcement, which was ahead of schedule and obviously quite positive for a little bit.

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: Certainly, we thought about

Matt Mexic, Med Tech Analyst, Barclays: it. Yes.

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: I would say that we had a great year first of all. 2024 was a fantastic year for us. At the beginning of the year, we guided to 10%, we grew at 18%. We saw double digit growth in MDI conversions, which is really the first time we’ve seen growth in MDIs. And we saw Mobi have

Matt Mexic, Med Tech Analyst, Barclays: sequential growth in demand

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: throughout the year. So we thought it was a mapped out the seasonality of the year very carefully over the last ten years or so. And we know pretty much what’s going to happen every week of every quarter. And if you look at the fourth quarter, we see consecutive growth in opportunities every week. And that goes from the very October to the December.

And as we were halfway through December, we had seen continued to see the growth in the opportunities. But strangely, there was softening the last two weeks of the quarter, which impacted us. And I think the other thing that happened is we had shipment we had made shipments the last week of the quarter. And historically, they would have arrived before the quarter was over for some reason, a number of them didn’t. So we had these two issues and ended up causing us to miss U.

S. Guidance, which I think was that’s the number one thing I think that drove the disappointment. I think the other thing that happened is that we did set a conservative guide for 2025. And again, that’s our philosophy. But as we just went through, there’s a lot of really exciting things that are happening.

And we absolutely intend to beat that. But that’s and that’s the intent really as we expect to exceed what we put in there. But that’s what we commit to, because that’s what we feel comfortable with at this point in time. So I think that that’s another factor that contributed. I think that the there is just based on what you mentioned, we are expanding the U.

S. Sales force, which is essentially done now. But I believe there is a fear that there might be disruption that comes along with that, that others have experienced, which I have to say we intentionally designed the expansion to minimize the disruption. We know how disruption occurs. And again, it’s been very intentional.

And so we think that’s overblown. And I think when there’s sales force expansion, when there’s we’re going direct OUS in certain countries, when those things happen, I think that there there’s a wait and see. Let’s just wait and see to have a scope and we’ll get back in after this has been done. But as I said, it’s been managed carefully. We feel that the impacts are going to be de minimis this year.

And but I think those are probably the main issues contributing to that response.

Matt Mexic, Med Tech Analyst, Barclays: Yes, yes. I think after I mentioned last year, not to call out that companies have been widely discussed, but they realigned their sales force in a, I’d say it sounds like a much different way. Yes, every new call point. You’re expanding and you’re going direct, expansion in U. S.

And going direct geographies in Europe.

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: And we’re not going we’re going direct in select countries in a stepwise manner. So it’s not going to be dramatic. It’s just going to be managed carefully.

Matt Mexic, Med Tech Analyst, Barclays: Right. Okay. So instead of moving a bunch of sales reps around, which might be one definition of realignment or changing your sales force, you’re is this I mean, I don’t want the words in your mouth, but like more traditional like splitting territories, adding territories, adding reps, like investing in places where you see opportunities for penetration like that kind of expansion is that Yes, I

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: would say we want to increase share voice, reach and frequency. When you consider what’s going on in the market, there’s increased competition. There’s new sales forces out there. There’s when you look at our big competitors, they have larger sales forces. It’s a logical thing for us to do is expand the sales force to maintain our competitive footprint.

And when you look at the we did realign several territories, but and we added territories as well. But when we did that, we minimized the effect by controlling the number of new physicians, the new call points that people in those territories have. And I think that’s really the source of disruption is when you have to establish a new relationship, you got to get in there and sell the product. Well, we minimize that. And so we think that it’s definitely manageable.

Matt Mexic, Med Tech Analyst, Barclays: Okay. So maybe a couple of things about the sales force is increasing share of voice. You have new competitors in Beta Bionics kind of investing in their sales force and making a push now. But also you’re communicating, I guess, with clinicians in a different way in certain geographies as you kind of ramp up your access to pharmacy. Maybe talk a little bit about how you expect growth in ’twenty five, performance of the sales force in ’twenty five to maybe be different than it was in ’twenty four?

Yes.

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: We have new sales leadership and they have brought in new analytics and tools to help the sales organization become more effective. And in ’twenty four, we piloted these tools. And we found out it’s basically it’s external data on how our competitors are doing in each individual practice, our own data and then characteristics of the physicians, what are the selling points that physicians appreciate. And so we armed our sales organization with this data today. So they actually can go and hunt and go to the locations that have the biggest opportunities for us to grow.

So these tools I think are really important. So that combined I think with the new the size of the sales force, I think we’re going to be a lot more effective this year.

Matt Mexic, Med Tech Analyst, Barclays: Okay. Anything again, kind of comparing ’24 to ’25, because I mean, there’s some things that are new and different than ’25, the sales force we already being one of them. But guiding to sort of call it low double digits delivering high double digits last year. What were some of the difference makers that surprised you to get to that level of performance? And how should we think about the opportunity to outperform this year?

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: Yes. I think last year at the beginning of the year, we had just introduced several new products, G7 integration, FreeStyle Liberty three, our Tandem source. And then early in the first quarter, early in the first quarter, we introduced Mobi. And so really, I don’t we don’t we didn’t give ourselves any credit for any of those introductions. And certainly, we saw significant benefit from the G7 integration from Mobi’s integration Mobi’s availability.

And so I think that the processes don’t commit until we understand. And we saw continued growth through the entire year. And I think it was largely a result of the new products that we brought to market earlier in the year.

Matt Mexic, Med Tech Analyst, Barclays: Even though they kind of scaled in, I mean like Mobi was sort of quarter speed, first quarter, half speed. That’s why I’m

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: saying this year, as we have a full year of Mobi on the market with new features and capabilities, we expect to see the continued benefit of that on our

Matt Mexic, Med Tech Analyst, Barclays: new product starts. Okay. But not dialing in any benefit really from these new products, same blocks? Yes.

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: The new products are not on the market yet. I mean, we have some, we have single digit growth in new products largely driven by Mobi. Okay. New starts largely driven by Mobi. Okay.

But I think when it comes to the features that we’re adding, there’s no credit for those. Is minimal no credit for pharmacy or Type two in the guidance either. And we all know that those are going to have a favorable effect on our business this year. It’s just that we don’t want to commit not knowing what would be likely to be. Sure.

Overcommit and hit

Matt Mexic, Med Tech Analyst, Barclays: a soft spot or something. Coming back to the things that did surprise you in the fourth quarter, anything I’m sure you’ve thought a ton about this, but anything that you can do now that that’s happened to kind of mitigate the risk of those kinds of mid late quarter surprises

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: going forward? Yes, I think when we look back and try to ask what would really happen. Certainly, economics is part of inflation. I think concern for potential recession, those sorts of things are impacting people’s purchasing habits. And you see it across the board in other industries as well in markets and things like that.

So that was that’s a factor. And then I think the other factor is in there’s more people today who are purchasing high deductible insurance plans. And last year and over the last couple of years, the CGM manufacturers have gravitated towards pharmacy and the majority of their business now goes through pharmacy. So the impact on the deductibles is minimized. Therefore, in certain cases, we think people’s deductibles just haven’t reset and they decided to wait as opposed to purchasing a system.

Right. So I think a combination of those two things. When you look at next year, I think that we have continued to emphasize the we have a payment plan that’s also available for people who want to just distribute the upfront across a couple of years if necessary. Pharmacy channel also is going to reduce the out of pocket for the patient, which is really one of the main reasons we’re doing that. And then I also think that pharmacy channel provides us access.

I mean, it’s easier for the physician to prescribe it, it’s easier on their practice. And so I think the benefits of that can have a favorable impact. And we intend to I mean, we have 20% of covered lives today, which is a huge step for the first year really focusing on the way we have. And we definitely plan to improve that number, increase it and really take advantage of it and push as much product as possible through the pharmacy channel.

Matt Mexic, Med Tech Analyst, Barclays: Okay. That’s helpful. And maybe just on margins, and I’d also say if anyone has a question in the audience, feel free to put up a hand. But on margins, you’re obviously investing in field in the middle of the P and L for sales in U. S.

But you’re converting some of your geographies to direct to direct. So maybe talk about those offsets, the benefits where we should see them obviously not so much of a benefit and maybe not in ’25 for the investments in the field force, but how those things maybe offset each other as you get through the end of ’twenty five and

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: into ’twenty six? I’ll say that we’re intently focused on profitability. It’s very important for the business. We understand that we’re a billion dollar company. We really need to do a better job there.

If you look at in ’twenty four, our EBITDA, we were negative 1% EBITDA and 25%, it’s 3%. And I think that the company and the team are really focused on looking for costs, taking costs out to enable us to grow the sales force and go direct and at the same time improve the profitability position. So I mean, we really have spent a lot of time over the last couple of quarters looking for cost reductions and savings. So we can grow. So that’s certainly one of the things that has happened.

When it comes to the OUS, it’s a 26 actual event. This year is prep. I mean, we’ll be adding the team, building out the capabilities of the team, but nothing is going to start until 2026. And then there’s going to be probably a 2627 timing to get several of the countries from distributor to direct. And the benefit for us, I think really when you consider that is we have control over the sales force, we have control over the message.

And we think we do a really good job here in The States and I think we will there as well. So there is just in terms of just relationships with the KOLs, clinical relationships, marketing relationships, there’s a benefit for us doing that. And then there’s also the margin benefit as well. So I think the combination of those two things just it’s back to we think we’re at a point in the company’s size and history. There’s a level of maturation that comes along.

And this is a natural step that business has taken. We’re just doing that now.

Matt Mexic, Med Tech Analyst, Barclays: Got it. Okay. So, yes, the EBITDA was one of the things that obviously needed to come down. Street estimates were a little higher when you printed and guided. I guess, maybe a hard question to answer, but it seems like Looks like Katie answered that.

Maybe this is for Katie. But there’s some amount of that like I would call it a reduction, but coming in lower than consensus that was aligned with coming in a little more conservatively on the sales side as well. Yes, that’s true. So anything else that you’d attribute to a more tempered, initial look at EBITDA for ’25 anyway?

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: We certainly want to hit the number and we want to beat it. And I think when you look at the things we just spoke about, we have 10% to 12% or 10% to 11% in the guide. With the things I just outlined for you, we expect it to be numbers. That will just it will drop to the bottom line obviously. And the pharmacy channel in addition to lower out of pocket, improved access, the ASP is also beneficial.

In ’twenty and ’twenty five, we’ll also see the benefit of Mobi being on the market and the margin benefits of that. So those things are again, a lot of the things we’re talking about that aren’t planned will absolutely have a favorable effect on the top and bottom line.

Matt Mexic, Med Tech Analyst, Barclays: Okay. So with upside to sales and not that we’re like predicting or our estimates are in line with your guidance, but should you outperform in any way like you did last year and then some of that should result in slightly.

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: I think the other thing too is the we’ve made a lot of investments in R and D over the last several years. We’ve acquired few businesses. We’ve taken on their staff. And so, this year, I don’t think there’s any reason to grow as aggressively as we have in the past. And I think we definitely would leverage I mean, we expect to grow the top line a lot at a higher rate than we would the R and D team.

So that’s another big expense that’s been part of it. Okay. One

Matt Mexic, Med Tech Analyst, Barclays: on this like, I guess, a little bit of a surprise. You mentioned pharmacy and pricing benefit leading into this contract during last year and a lot of the discussion. Even after the quarter was well, pharmacy is good, but pharmacy will be bad for cash flows. But it sounds like it’s sort of one of the surprises was it’s like a little better for cash flows, maybe no

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: different cash flows. Yes, it’s interesting. I think there is a perception that the only way this would work in pharmacy if we were to have an economic situation where we gave away the pump. It was all of the revenue came from increased ASP for the supplies. Right.

Well, that didn’t happen. We actually spent quite a bit of time with these large organizations and help them understand the model. And there was this educational process. And in the contracts that we have signed, the economics are very much like they are for the DME model, meaning that we get a large upfront for the pump and then the supplies we pay on a quarterly basis over a four year period of time. In both cases though, the ASP for the two of those swap supplies in the pump are higher than what we’re seeing through DME.

But it’s the same economics. So I think if we were a startup, that would be what we would want. I think that the annuity model doesn’t really make sense. But I think that as we continue to develop contracts, we would anticipate we will potentially have agreements that do that where you have to give away the pump in. But I think we feel comfortable that we can tolerate that.

Matt Mexic, Med Tech Analyst, Barclays: Right. Yes. I think the mantra all along has been obviously better to be in pharmacy than not to be in pharmacy. But access been

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: attractive. I mean, I think the way we look at it, it’s really multichannel. We want to have access to both and we want to be able to, I mean, depending on what happens in one of the other move business and volume to the most optimum financial situation.

Matt Mexic, Med Tech Analyst, Barclays: Right. And given what you said about some sensitivity, deductibles, consumer kind of behavior, if you will, of these folks not wanting to plunk down just yet in that market, this kind of take some of the edge off of that going forward. Absolutely. So you’re at maybe talk about where you are in terms of covered lives and coverage, because I think you’ve also made a bit more progress on the pharmacy side than at least we were expecting. So what are you seeing now about by the end of the year, by the end of next year in terms of covered lives access by a pharmacy?

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: I think it’s back to our, this won’t surprise you, but rather than commit, we’ll just go ahead and do it. We’ve got 20% today, which is, I mean, we started off the year last year in 2014, let’s get a million covered lives. Well, we got a lot more than that. And there’s no reason to believe that we can’t continue to accelerate and achieve more than what was achieved in ’twenty four. We have a great team.

They’ve got a lot of experience. They’ve done this before in other companies. So it’s I think it’s just a matter of executing and getting these things done. But we definitely will continue to grow access the number of covered lives and take new into them. Yes.

And just to put a number on that 20% is like 30,000,000 or something? That’s right, twice that. Okay.

Matt Mexic, Med Tech Analyst, Barclays: Really? Wow, I thought covered lives were okay, so that’s great. Terrific. All right, so then maybe in the two minutes that we have, let’s just cover Type two. No, but I think just the question I would have is, I think you were distinguishing you made sort of some differentiated comments around Type two around the lift required like this is going to be a market development lift, this is going to be this is not going to switch it on and we’re just like penetration and pumps and Type two is just going to start to take off.

I mean, you sort of recognize the investment that you’re going to have to make and the market development is required. So maybe talk about like I want to ask you what percentage that gets to, you’ve talked about that or other companies have. But when do we start to notice that do you think in your results? Is it six months away? Is it nine months away?

Is it 2026 in terms of adoption and penetration in Type two?

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: Yes. I think that the introduction of AID systems in Type one has it’s been noticed by people with Type two. In Type two, it’s very similar to Type one. You have to have visible insulin and you have that for longer term comorbidities if you’re not managing it properly. And so we’ve done a quite a bit of research with the Type two community.

And what we’ve learned is that they’re more willing to consider pumps at this point. And so we would call these people near term pumpers. They’re well educated. They’ve got good jobs. They’ve got good insurance and they care about their health.

And why wouldn’t they use an AID system that’s going to help improve their health and the therapy benefits are substantial. So I think that a couple of years ago, we there’s about 100,000 people using pumps today. That could get up to which is about five percent penetrated. So we thought that could be potentially ten percent or fifteen percent. And I think now with the new technology, they’re simpler, they’re smaller, they’re more discrete mobile control, all these benefits have come along with them.

These people are now willing to consider it. So our numbers would say we can get north of 25% or 30%, which is that’s a big change right there. I think that there is from a technology point of view, I think we need to simplify the system and that’s something that we’re obviously focused on. When you see the Type two data, you’ll see that there’s things that we’ve done to even simplify the interaction with the system on the existing products. And this Control IQ plus is coming out.

It has some features on it that simplify the starting process for somebody with MDI substantially. So we’re doing these things already, so that we think that that’s going to be a benefit. But it’s an ongoing thing that we’re going to have to do over time is to really optimize the product. I think that when you look at access, the commercial plans all cover Type two as if it’s Type one, it’s really the government plans. And so there’s activities we have underway to reduce some hurdles that the government plans require to get people on a pump.

And I think that’s an important thing that we’re working on. Then I think it’s just I think that obviously Type IIs are prescribed by endos and PCPs, more PCPs. And so I think there is just getting into that area and getting the PCPs trained, understanding the technologies, the benefits of the technology and getting them comfortable prescribing them. So I think that we’re going to start with a pilot and a pilot in multiple territories. And

Matt Mexic, Med Tech Analyst, Barclays: we’re

John Sheridan, President and Chief Executive Officer, Tandem Diabetes: going to understand how the training, how the data how the physicians respond to the data, how the marketing materials work, how the access works, and then we’re going to optimize that. And I think as soon as we feel comfortable that we’re making headway, expand it to the remainder of the country. And so I think that there is there will be immediate benefit from that once it’s there and once we start. But I think that it’s not going to be a step function change in demand. I think it’s going to be a gradual increase in demand over time.

And I think it has the opportunity to accelerate as more salespeople are selling it, more PCPs are aware of it and the data is out there. And I think that having more than one company in the market is beneficial because we’re all doing the same thing and we’re doing it to the same people. So it’s going to take a little time. Like I say, it won’t be step function, but it will definitely be meaningful. I think we’re doubling the TAM.

And so that’s a big deal for us.

Matt Mexic, Med Tech Analyst, Barclays: Sure. Well, thanks so much. We’re time. So I appreciate you coming. Good talking to Matt.

Yes, always. Thank you.

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