This is one of those situations where the technology story and the stock chart are telling two different truths. Clinically, the category is real and adoption has years of runway.
Financially, the company has been tightening execution and pushing a next-gen platform.
But the market is fixated on two near-term landmines of reimbursement mechanics and whether the rollout was as smooth as investors were led to believe.
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The Setup
Inspire Medical Systems Inc (NYSE: INSP) sells an implantable therapy for obstructive sleep apnea, aimed at patients who cannot tolerate CPAP.
The stock is down hard over the past year and still well below its prior highs, which tells you the market is no longer paying for a clean growth glidepath.
At roughly $98, investors are asking a narrower question now: can Inspire get back to predictable procedure growth without reimbursement surprises, operational hiccups, or legal overhangs?
What Inspire Actually Does
Inspire’s core product is hypoglossal nerve stimulation.
In plain English: a surgically implanted device stimulates the nerve that controls tongue movement, helping keep the airway open during sleep.
Patients are typically diagnosed and funneled through sleep clinics, then evaluated for eligibility and referred to implanting centers.
The company’s bull thesis has always been straightforward: large underpenetrated market, strong clinical data, and a therapy that can feel like a life upgrade for the right patient.
The thing investors underestimate is that medtech scaling is not just demand.
It is training, reimbursement workflows, center capacity, coding, and the boring operational plumbing that determines whether procedures actually happen on time.
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Why The Stock Has Been So Weak
1) Reimbursement and coding noise spooked the market
In late 2025, two Medicare Administrative Contractors removed CPT code 64568 from their Group 1 CPT codes for hypoglossal nerve stimulation, a move that created uncertainty around payment mechanics and rates.
Even if the underlying procedure still gets done, coding shifts can slow clinics down, create claims friction, and make investors wonder whether guidance assumptions need to be revised again.
That uncertainty matters more than usual when a stock is already trading like trust is fragile.
2) Product transition execution became a story, not just a line item
Inspire has been transitioning from its prior generation device to Inspire V. Management has highlighted progress on conversion and training, plus benefits like faster surgical time.
But transitions create inventory complexity, uneven center readiness, and short-term variability in procedure timing.
Those are normal medtech growing pains, but the market punishes them when expectations were set too cleanly.
3) Lawsuits added an overhang
A securities class action has been publicized alleging misstatements around operational readiness and the Inspire V rollout (including billing and inventory issues), tied to a prior guidance reset.
You do not need to assume the worst to recognize the practical impact: some investors simply will not touch a name with litigation headlines until the calendar clears.
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The Bull Case
1) The clinical foundation still looks durable
This is not a gadget chasing a trend. It is a therapy category with growing physician familiarity and a patient population that is not going away.
If Inspire executes, the long runway is still there.
2) Inspire V can be a real operational unlock
The best version of this story is not just better outcomes. It is throughput. Management has discussed benefits like reduced surgical time and steady progress in rolling the platform through implanting centers.
In medtech, small efficiency gains can translate into more procedures per day, faster scheduling, and better economics for centers.
3) Reimbursement can still improve, even if the path is messy
Before the recent coding disruption, the broad direction of travel was constructive: better alignment between physician payment, facility economics, and the real cost of delivering the therapy helps adoption.
Management commentary in late 2025 pointed to improving reimbursement visibility into 2026.
The point is not that reimbursement is risk-free. The point is that if clarity returns, the category’s economics can look better than investors currently fear.
4) GLP-1s may expand the funnel over time
GLP-1s are a weird narrative trap for sleep apnea. Some investors worry patients will delay procedures while trialing weight loss meds.
But more GLP-1 adoption also means more clinic traffic, more diagnosis, and more pathway creation for patients who still need therapy when CPAP fails or weight loss is incomplete.
This dynamic has been part of management’s discussion, and it is plausible that the net effect is ultimately funnel-expanding rather than purely cannibalizing.
5) A beaten-down medtech can re-rate quickly when trust returns
If procedure growth stabilizes, coding confusion fades, and the company guides 2026 with fewer caveats, the market does not need perfection to re-rate the multiple.
It just needs predictability.
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The Bear Case
1) Coding and reimbursement disruption lingers longer than expected
The fastest way for this stock to stay stuck is if administrative friction slows procedures or creates persistent uncertainty about payments.
The late-2025 CPT code change by Medicare contractors is exactly the kind of issue that can drag into quarters, not weeks.
2) Inspire V transition remains a source of operational noise
Even if the device is great, adoption curves can wobble when inventories, training, and contracting vary by center.
Any hint of another guidance reset would likely get punished hard.
3) Lawsuits become a larger perception problem
Legal headlines can keep institutions on the sidelines. Even if the business performs, the stock can trade with a discount while investors wait for clarity.
4) Competition and site-of-care pressures creep in
Sleep apnea is a valuable market. Competitive alternatives, pricing pressure, or shifts in where procedures are performed can tighten the story over time, especially if reimbursement is not clean.
What I’d Watch Next
Medicare and commercial payer clarity: Do coding and claims workflows normalize, and do implanting centers report fewer reimbursement headaches?
Procedure volume vs revenue timing: Do procedure trends look steady even as inventory and mix normalize?
Inspire V conversion cadence: Any update that signals the transition is truly past the messy middle.
February catalyst: The company’s next earnings window (with some calendars pointing to mid-February) is the obvious checkpoint for guidance, procedure commentary, and how management frames reimbursement risk.
Legal timeline headlines: Not because you can model them precisely, but because sentiment tends to move on milestones.
My Take
INSP looks like a classic medtech reset: the underlying therapy can still be a long-duration winner, but the stock is being forced to earn back credibility one quarter at a time.
The bull case is not about calling the bottom.
It is about believing the operational story can get boring again: clean coding, clean claims, smoother conversion, and steady procedure growth.
If those boxes start getting checked, the stock does not need a perfect macro backdrop or a heroic narrative. It just needs fewer surprises.
But until reimbursement mechanics and execution questions quiet down, expect this one to trade more on confidence than on pure clinical merit.
That’s all for today. Thank you for reading. If you have any feedback, please reply to this email.
Best Regards,
— Adam Garcia
Elite Trade Club
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