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Earnings Transcript for TNDM - Q4 Fiscal Year 2023

Operator: Thank you for standing by, and welcome to Tandem Diabetes Care’s Fourth Quarter 2023 Earnings Conference Call. [Operator Instructions] I would now like to hand the call over to EVP and Chief Administrative Officer, Susan Morrison. Please go ahead.
Susan Morrison: Hello, everyone and thanks for joining Tandem’s 2023 fourth quarter and year end earnings call. As a reminder, today’s discussion will include forward-looking statements. These statements reflect management’s expectations about future events, product development time lines and financial performance and operating plans and speak only as of today’s date. There are risks and uncertainties that could cause actual results to differ materially from those anticipated or projected in our forward-looking statements. A list of factors that could cause actual results to be materially different from those expressed or implied by any of these forward-looking statements is highlighted in our press release issued earlier today and under the Risk Factors portion and elsewhere in our most recent annual report on Form 10-K, quarterly report on Form 10-Q and in our other SEC filings. We assume no obligation to publicly update any forward-looking statements, whether as a result of new information, future events or other factors. Today’s discussion will also include references to a number of GAAP and non-GAAP financial measures. Non-GAAP financial measures are provided to give our investors information that we believe is indicative of our core operating performance and reflects our ongoing business operations. We believe these non-GAAP financial measures facilitate better comparisons of operating results across reporting periods. Any non-GAAP information presented should not be considered as a substitution independently or superior to results prepared in accordance with GAAP. Please refer to our earnings release, quarterly report on Form 10-K and the Investor Center portion of our website for a reconciliation of these measures to their most directly comparable GAAP financial measure. Leading today’s call is John Sheridan, Tandem’s President and CEO, who will be joined by Leigh Vosseller, our Executive Vice President and Chief Financial Officer. I’ll now turn the call over to John.
John Sheridan: Thanks, Susan. We appreciate everyone joining us today. Looking back on 2023, we exited the year on a high note, demonstrating positive momentum across key areas of our business. In many ways, our efforts in 2023 focused on building and preparing for the future as we executed on multiple strategic initiatives. Most notably is the unprecedented accomplishment of being in various stages of launching 4 new products in the United States. These include two CGM integrations, along with the introduction of Tandem Source, our next-generation data management platform, and the milestone of adding Tandem Mobi, our new pump platform to our portfolio. Other strategic initiatives we completed include the onboarding of our European distribution center and driving operational cost savings across all products and processes through lean activities and other manufacturing efficiencies. We’ve also been evolving our organization as we’ve expanded our leadership by attracting key talent with global experience to complement the team and help us prepare for the future. Lastly, we made meaningful advancement in progressing our channel strategy in the development and in the development activities of our longer-term portfolio. The team has been executing particularly well on our strategy to provide people with insulin-dependent diabetes and their care teams flexibility and choice in insulin delivery. These achievements were made possible thanks to the hard work and perseverance of our employees. Thank you, everyone, for your continued dedication and efforts to contribute to building our business and executing our vision to improve the lives of people with diabetes. Evidence of this vision was highlighted in recent months, as we are now the only pump company to offer users choice in CGM integration in the U.S., having launched the t
Leigh Vosseller: Thanks, John. As a reminder, unless otherwise noted, the financial metrics I’ll be discussing today are on a non-GAAP basis. Reconciliations from GAAP to non-GAAP results can be found in today’s earnings release as well as on the Investor Center portion of our website. We ended 2023 with more than 450,000 customers receiving the benefits of the t
John Sheridan: Thanks, Leigh. As you can see, it was a busy close to 2023 and an exciting start for 2024. Thanks to the unwavering commitment to our teams, we are now in the home stretch of completing the rollout of four new products, making significant progress on the next phase of our pipeline and maintaining the highest levels of customer service while generating operational efficiencies. The opportunity for Tandem Diabetes Care remains meaningful, and I look forward to providing you updates throughout the year as our company continues to progress. We will now open up the call for questions.
Operator: [Operator Instructions] Our first question comes from the line of Steve Lichtman of Oppenheimer & Company. Please go ahead, Steve.
Steve Lichtman: Thank you. Hi, guys. Congratulations on the progress, including the recent launches. So I guess my question – I know it’s very early, but what are you hearing from the field in terms of where new interests lie as it relates to Mobi versus t
John Sheridan: Hi, Steve, how are you doing? Well, first of all, I’ll say the response has really been incredibly positive from early access participants and ATPs. A lot of ATPs are actually using it, and it’s certainly exceeding our expectations. I mean, it’s tiny. It’s very light with an adhesive sleeve. It’s expanding wearability options, and the cellphone control provides very discrete interactions with the system. People actually forget that they have it on and the common sentiment we’re hearing is it’s liberating and it provides freedom from the burden of diabetes. I think Mobi is going to change the narrative from tube to tubeless to wearability and choice with the number one rated AID system. And our sales force is highly motivated. There is been HCP events that have been occurring over the last several weeks. They are very well attended. And I think that the response and feedback has been very positive. So I think it’s going to – I think there is certainly going to be people out there that are interested in t
Steve Lichtman: Got it. Great. And then just as a follow-up to that, I know you’ve said that Mobi kind of allows you the first steps into the pharmacy. I know you mentioned that. Can you talk a little bit more about sort of the next steps there and maybe a little more detail on what you mentioned in the prepared remarks?
Leigh Vosseller: Sure. Thanks, Steve. So when it comes to pharmacy, you’re correct, Mobi is our introductory product into that channel, and it’s proving itself as we’re having active conversations these days with different payers and PBMs. And so we feel very confident that we will be signing a contract this year. We don’t, right now, have anything factored in, in terms of – from a material perspective in 2024. But as we progress, we will certainly give more information on that.
Steve Lichtman: Great. Thank you.
John Sheridan: Thanks, Steve.
Operator: Thank you. Our next question comes from the line of Matt Miksic of Barclays. Please go ahead, Matt.
Matt Miksic: Hi, thanks so much for taking the question. And congrats on the upside here in Q4 to your estimates, to our estimates and projections. So great finish. It’s been – for a lot of folks, kind of a bumpy year of preparation for the future, as you talked about, John. So one question on – some of the comments you made around renewals, strong renewal year, and some of those folks seemed like they were kind of out of warranty for a period of time and renewing. And I’m wondering if you have any data points you picked up from these folks through your – your channels or surveys or anything that would indicate like where have some of these folks been? What has kind of caused people to come back to t
Leigh Vosseller: Sure. So thanks for the question. So renewals is one of the best, brightest spots that we’ve seen in 2023. As you mentioned, it has been quite a challenging year. But even with that, we have been capturing our renewals at peak rates compared to even with 2022 and what we’ve seen in our history. And I think it says a lot about when there are a number of new products on the market, Tandem customers are sticking with Tandem and choosing our products once again. So for the people that have been sitting out there for a while, I mean, these are folks who are just content to use their product out of warranty. And as they are thinking ahead to what comes next, they are being motivated by some of the new opportunities that are being offered. For instance, the G7 integration, the Mobi switching opportunity. And so I think that’s what’s driving people forward who have been out there. But we’ve been very successful with people whose warranties were newly expired as well. In fact, everyone in 2023 whose warranties expired, we have already renewed 50% of them. And so I think that’s great progress for us.
John Sheridan: And I’d also say that we’ve said our goal is 70%. And I think that if you look back over the last couple of years, we are absolutely achieving 70%.
Matt Miksic: Great. Well, congrats on that, the follow-up. I was curious, John, you mentioned – some of the things that you’re doing to kind of expand the utility of your recently launched product, Mobi and t
John Sheridan: Yes. Sure. Well, we’ve talked about a portfolio of products and that being essential to address the many segments that exist within diabetes today. And our platforms are clearly t
Matt Miksic: Okay, understood. Thanks so much.
John Sheridan: Yes.
Operator: Thank you. Our next question comes from the line of Matthew O’Brien of Piper Sandler.
Unidentified Analyst: This is Phil on for Matt. Thanks for taking our questions. I guess just starting on guidance, specifically for Q1. By our math, it looks like about 15,000 pumps here in the United States. How many of those are renewals? How many of those do you expect to be new pumpers? And I would assume that this is the case, but is this your expectation for the last big quarter of pausing ahead of Mobi’s commercial launch?
Leigh Vosseller: It’s great question. Thanks. So as we think about the Mobi trajectory, to your point, Mobi just became commercially available in the middle of the first quarter. It will become available with G7 in late spring. So we do still have a bit of this dynamic of there may be people waiting for the right feature that’s appropriate for them. And so the guidance in Q1 reflects that for certain that there might be people pushing to a future quarter, but the interest is still there. And so we’re really excited about that opportunity. In terms of renewal versus new shipments, we’re not breaking out that piece of information. But if you want to look back to what the opportunities were, you could refer back to the first quarter of 2020 as a reference point for what new opportunities become available. But again, the timing of Mobi availability with the appropriate features might still affect when people make that next purchase.
Unidentified Analyst: Thanks. And just as a quick follow-up. I guess just given all the pausing that we’ve seen in the market, do you expect a snapback? I know you just said people might continue waiting for a specific feature. But outside of typical seasonality, is your current guidance baking in like an outsized Q3, Q4? What are your thoughts on cadence throughout the year?
Leigh Vosseller: Sure. So the way we built the guidance for the year, keeping in mind that we do not foresaw have any inflection for the new products that are coming to market. So you can think about it as somewhat standard seasonality, maybe a little more depressed in the first quarter. I wouldn’t like to use the word depressed, but a little more pressured right now because of that Mobi timing. And really thinking back to how the renewal is scale. They are one of the largest pieces that are underpinning what our guidance is for this year, on top of supplies. And so the way the renewal scaled 4 years ago, 35% of those don’t become available until the fourth quarter themselves. And so I would say the scale is more about when renewals become available. And then as we get more information on the trends for the new products, we will certainly give updates to that in future quarters.
Unidentified Analyst: Makes sense. Thanks so much.
Operator: Thank you. Our next question comes from the line of Brooks O’Neil of Lake Street Capital Markets. Please go ahead, Brooks.
Brooks O’Neil: Thank you very much. Good afternoon. I have a couple of questions. I think the integration with Libre is one of the more exciting and interesting opportunities you have this year. Is it too early to say whether you think there could be a tailwind behind new pump purchases for you guys? Or what are you seeing from the response so far?
John Sheridan: Well, I mean – first of all, hi, Brooks. How are you doing? We have had a great deal of interest and excitement about the FreeStyle Libre 2 and G7 integration. And as you know, we have the only system in the market today that offers choice and sensor integration. And all the units that we’re shipping today have the latest software that enables G6, G7 and FreeStyle Libre 2 implementation. So everything that’s being shipped since the early part of January is that way. And then we’ve also had a significant number in the tens of thousands of pumps that have been updated using the remote software update process. So we are excited about it. We agree. We think it’s going to be a meaningful part of our longer-term growth. And – but we specifically don’t plan to talk about pump volumes relative to the sensor integrations at this point in time. But we think it’s going to be meaningful going forward.
Brooks O’Neil: Sure. So the second question I had was, obviously, this French rebate program is something new. I was hoping perhaps Leigh could just give us a little bit more detail about what that program looks like, what’s driving that and whether you think it’s something other countries in the international sphere or the EU might adopt as well?
Leigh Vosseller: Sure. I’ll do the last part of your question first. It’s very unique to France. It’s common for them to use a rebate structure, first time for us. So we haven’t seen this in other markets. So today, we feel like it’s contained there. The biggest, most material impact we expect to see would be what we just reported in the fourth quarter. And this is from the implementation, I would say, of it. And so if you think about it, this is a rebate liability that’s associated with the installed base we’ve already amassed in France. So as we look ahead, it will just blend into our normal ASPs as we ship new pumps and recognize that obligation alongside it. And so I hope that we’re not talking about it in the future. I think the good news is that Control-IQ as an advanced algorithm has been differentiated from a reimbursement perspective, and we look forward to driving the business in France and all of our markets outside the U.S.
Brooks O’Neil: Okay, thank you, Leigh.
Leigh Vosseller: Sure, thanks, Brooks.
Operator: Thank you. Our next question comes from the line of Chris Pasquale of Nephron Research. Your questions please, Chris.
Chris Pasquale: Thanks. John, the competitive landscape has evolved quite a bit over the past year, but your mix of MDI conversions versus competitive switches has stayed pretty consistent quarter-to-quarter. Curious how you’re feeling about the competitive headwinds you’re facing today? And do you feel like you kind of have the stage to yourself here with the Mobi launch to really make the kind of impact that you’d like have some of those other launches kind of gone through their initial hype cycle to clear the field for you a little bit?
John Sheridan: Yes. Thanks, Chris. Well, certainly, we think that the diabetes market is large and under-penetrated. And so there is a lot of opportunity both in the U.S. and outside the U.S. I would say that when you look at the last year or so, it’s – we’ve it’s the competitive pressures that we saw in the U.S. were pretty much in line with expectations. There was definitely pressure, but they stabilized probably early in the 2023 time frame. And there is a number of new entrants, and they are going to come and go. But I would say that the primary competitors we have are the two big ones. And I think you know who they are. Outside the United States, the environment is becoming increasingly more competitive. And we’ve been hearing this from our distributors. It started happening roughly in the second half of last year. And there is been one patch enter that was the U.S. that’s come into the market with a new device, and there is also been a smaller OUS competitor that has generated some noise and made some progress. So I think that you’re exactly right, though. I think we are focused on our new products, and we think these new products position us to take advantage of these larger markets. This is really the first time we will have had a significant new product opportunity in the last 18 months. And I think that when you look at our competitors, both of them have brought new products to market. So I think we’re very focused on getting these devices to market. We’ve got a – we’ve got new sales leadership. We’ve got a very energized sales team. And I think both in the U.S. and OUS markets, we think that these products are going to make a big difference to turn things around for us.
Chris Pasquale: Thanks. And then would just love an update on the Type 2 opportunity, how you’re thinking about that for both of the products and time lines there.
John Sheridan: Yes. We’re actively engaged in the clinical study. We’re enrolling patients, making good progress there. I think from a timing point of view, the study is probably going to get done sometime in the mid to latter half of this year, a filing. And I would say that roughly rough time frame, we’d probably see the product in the market sometime in 2025. I think that we believe that Mobi, with advanced sensor integrations and a Type 2 indication, is going to be a very appealing product to the Type 2 community. And we’ve got – we’ve got a lot of focus on developing the business case, the commercial strategy, the launch strategy, the product strategy for Type 2 underway as we speak.
Chris Pasquale: Great. Thank you.
John Sheridan: Yes.
Operator: Thank you. Our next question comes from the line of Travis Steed of Bank of America. Please go ahead, Travis.
Travis Steed: Hey, thanks for taking question. I wanted to ask about Q1, specifically on the Q1 shipments. Just kind of what you’re seeing in January and February, why you’re starting off the Q1 revenue guide where you are? And on the margins down 15% in Q1, just trying to get comfort with the margin ramp over the course of the year. Looking at last year’s ramp starting the year at 11.5% margin, getting to negative 1 or almost breakeven for ‘23. So ‘24 margins, a bit steeper on that ramp. So I just wanted to kind of get some clarity on your conviction and the margin ramp over the course of the year. And when does Mobi actually become accretive to margins? Is that something that happens in ‘24?
Leigh Vosseller: Yes. Great question, Travis. So Mobi is a big – it has a big impact on the margin profile this year. So if you look at any year, it’s not as steep of a tilt. It usually does follow comp sales across the year with the lowest in the first quarter improving across – through the fourth quarter. With the way the Mobi’s scaling, we anticipate it will be a little more pressured upfront and also not just with the COGS associated with the lower volumes that we’re producing, but the spending in order to effectively carry out that launch. And so across the year, we expect that as we’re building at higher volumes, we will start to see more and more benefit. And by the time we’re exiting the year. Mobi will actually start to be making a contribution to margins. So really, it’s a 2025 story in terms of seeing a real difference, and we still firmly believe it’s one of the best drivers of our long-term gross margin goal will get us more than halfway there. But this year, it’s going to start – it’s going to have a little steeper tilt just because we’re actually going to see momentum come from Mobi and that improvement as the volumes increase.
Travis Steed: Okay. Helpful. And maybe longer-term, like when you think about that 65% margin goal, I’d like to think about it in terms of like installed base. You had a 450,000 installed base today. I think before when you gave that 65% margin goal, the goal is for 1 million installed base. Is that the right way to think about what you need in terms of patient growth to get to that 65% gross margin longer-term?
Leigh Vosseller: Yes. That’s still the right way to think about it. It’s closely correlated to 1 million customers in the installed base.
Travis Steed: Great. Thanks a lot.
Leigh Vosseller: Thanks, Travis.
Operator: Thank you. Our next question comes from the line of Larry Biegelsen of Wells Fargo. Your question please, Larry.
Unidentified Analyst: Hey, this is [indiscernible] on for Larry. Thanks for taking the questions here. Just starting off with Mobi. How should we think about your share of new starts as Mobi rolls out over the course of the year? Do you expect it will expand the market, take share from MDI and other pumps and/or take share from X2 [indiscernible]?
John Sheridan: Yes. I would say that if you look back maybe 18 months ago, we would – we believe that on the MDIs coming to pump therapy, we are essentially splitting 50-50 with one of our competitors. And I think that as they brought their new device to market, that changed and that was probably more like 65-35 or maybe 70-30. I would say that we absolutely believe that that Mobi is going to reverse that trend, and we’re going to return. We may not get all the way back to 50-50, but we are definitely going to see improvement towards taking more MDI. We also think it’s going to have a favorable effect on competitive conversions as well. I mean the form factor, the wearability that comes along with this device is a substantial improvement. And when you talk to people who are using it, their response and reaction has been incredibly positive. And these are people who use a variety of different pumps besides Tandem. So, I think that we really believe that this is a year of transition for us. And when we have Mobi with the advanced sensor integrations, I think that’s going to be a meaningful favorable effect on our new pump starts.
Unidentified Analyst: Okay. Great. That’s helpful. And maybe just a follow-up on the renewal opportunity, how are you thinking about the renewal opportunity OUS in 2024? And do the same dynamics supply OUS as in the U.S.?
Leigh Vosseller: Yes, good question. So, I would say the opportunity is really beginning in 2024 for us outside the U.S. They do have standard 4-year warranties as well, much like we do here. The difference is right now in terms of expectations. We are assuming a somewhat slower ramp than what we are seeing in the U.S. right now. So, think of it back to what we experienced in the U.S. years ago as our distributors are developing their own best practices and learnings on how to go out and attract the renewal customers. And so we think it’s a great and growing opportunity, but we are being cautious about how we start off with it, and this will be the first year we start to see anything meaningful.
Unidentified Analyst: Great. Thank you.
Operator: Thank you. Our next question comes from Mike Kratky of Leerink Partners. Please go ahead, Mike.
Mike Kratky: Hi John. Thanks for taking my questions. So, in your presentation today, you highlighted that less than 40% of the 1.9 million people living with Type 1 diabetes in the U.S. use an insulin pump. What does your current guidance range assume as to where this goes by year-end 2024? What are the key factors that you expect to drive increased adoption for 2025 and beyond?
Leigh Vosseller: Yes. So, we haven’t given any specific color on where we think adoption goes by the end of this year, other than we think it can get to well north of 50%, even 60% in the coming years. And so a lot of that depends on how everyone is driving the market. We do believe with the list of products that we are offering that we will be the disruptors this year, and we will begin to expand the market in a way that we haven’t been able to in the last 12 months to 18 months. So, we are very excited about what we can do to push that forward.
Mike Kratky: Got it. And just maybe one clarifying one, I think you mentioned that your guidance doesn’t assume any inflection from the new product launches. I mean does that kind of include any kind of enthusiasm that you have talked about in terms of the Mobi launch and just how that impacts attrition rate or overall pump penetration?
Leigh Vosseller: So, the way we developed the guidance for 2024, I was thinking of it more along the lines of what are the predictable sources of revenue. And not building in anything incremental for what the new products can do for us. So, we are – like you said, very enthusiastic about the opportunity they bring to the table. But from a guidance perspective, we are starting with, I would say, more certainty in terms of the supply stream that we typically see, the renewal opportunity that is growing substantially. Just the number of renewals of opportunity alone is growing more than 30%. So, there is enough growth drivers in there that we can get to 10% growth worldwide. What we want to do is while we believe that we are going to make a real difference in the market with these new products, we want to gather data and trends to use that to better inform updates in the future so that we don’t get ahead of ourselves and you don’t get ahead of us. And so right now, it’s starting off with what we feel very confident in that we can see in front of us, and that has good predictable patterns.
Mike Kratky: Understood. Thanks very much.
Operator: Thank you. Our next question comes from Matt Taylor of Jefferies. Please go ahead, Matt.
Matt Taylor: Thank you. Can you hear me, okay?
John Sheridan: Yes.
Matt Taylor: Hey. Good afternoon. Thanks. So, I just want to follow-up on that question and clarify. I mean it seems like you are essentially guiding to growth just coming from supplies and renewals. Could you be specific about whether the guidance includes any potential for new pumps to grow? And I guess why wouldn’t they grow given the easy comps and all the new products that you have and the distribution center being in place?
Leigh Vosseller: Yes, it’s a great question. And so we are really focused on that buildup with the supplies that grow and the renewals that grow. And we do firmly believe the new products will make a difference. But until we see these data, these data points, we want to make sure that it’s an informed addition to the guide. And so right now, what’s factored in is that new pumpers will be approximately flat or even slightly down from what we saw in 2023. And as we gather these data points, we will be able to give you additional information about the direction that we are headed. But there are a lot of exciting opportunities to come. We want to make sure as well that we are basing it on trends and that they are sustainable trends because many times when a new product launches, you will see a little bit of a hype cycle with people who have been waiting, that pent-up demand coming in at one time. And so we want to make sure we understand how – what it’s going to look like after that point in the curve.
Matt Taylor: Okay. Thank you. I will leave it there. Appreciate it.
Leigh Vosseller: Awesome. Thanks Matt.
Operator: Thank you. Our next question comes from the line of Danielle Antalffy of UBS. Please go ahead, Danielle.
Danielle Antalffy: Hey. Good afternoon. Thanks so much for taking the question. Just wanted to ask Leigh a follow-up on the potential contract with the PBM that you are – may be signing before the end of the year. This might be too early to ask this question, but – and we are not going to model this yet, obviously. But just thinking about the financial impact there, I mean just the way the business is set up today and what that could mean. Again, not trying to model this right now, but just even qualitatively from a margin perspective and sort of as you make this shift and how you think about the business longer term as it relates to pharmacy versus DME.
Leigh Vosseller: Sure. So, I think one important point is that we intend to be a multichannel company. Our number goal with advancing into the pharmacy is to get the broadest access possible and to get to the lowest out-of-pocket cost for a patient. Pharmacy can be a good addition to what we offer today to DME, but there are still times where DME might be the better solution. For example, today, we still have roughly 30% of our direct patients that don’t even have an out-of-pocket when they buy the pump. So, what we want to make sure is we are getting the right solutions for people. What does this mean for the business long-term, when you get in the pharmacy channel, it opens the door, I would say, for other opportunities to look at your business model. It’s too soon to say which way this will go and it may vary by payer and by PBM. It could look just like the DME from the overall revenue perspective or it could look different with shifts of more dollars to supply than off of the pump. And so that’s the TBD part that we will talk to in the longer term as we have more information about the contracts that are in place and the materiality of those to the business.
Danielle Antalffy: Got it. And then just a quick follow-up, as we think about integration with G7, but especially with Libre – and Libre has a very large Type 2, including insulin-intensive Type 2 base. And just curious about how you are thinking about – I hear what you are saying regarding guidance for this year, but just over the next few years and access to the very large Libre installed base, many of whom are insulin-intensive Type 2, and what that could mean for Tandem? Thanks so much.
John Sheridan: Yes. I mean the product is very popular with the Type 2 community in the U.S. and particularly the OUS. And so we see that as a big opportunity for us longer term as well as the Type 1 community as well. I mean there is a significant number of people in the U.S. today that are using the FreeStyle sensors that are not using pumps. And so it’s almost – it’s a clean slate for us to go after and work with Abbott to basically get people aware of the benefits that pump therapy has. So, certainly, in the longer term, we think that integration with Abbott is an important part of our getting to 1 million people using the product in the next several years.
Danielle Antalffy: Thank you.
Operator: Thank you. Jayson Bedford of Raymond James, your line is open.
Jayson Bedford: Good afternoon. Just a couple for me maybe, of your G7 integration so far, what percent have been kind of internal conversions, if you will, versus new users?
John Sheridan: We haven’t been specific about that. I don’t think we are going to talk specifically about people using either of the sensors. I would say that there has been significant uptake. I would say probably – since there is like many tens of thousands who are updating the – have updated their pump, that is probably a larger number at this point in time. But that’s about as much information I think I can give.
Jayson Bedford: Fair enough. Maybe just going lower on the P&L here, wrking through the model, it looks like there is a bigger step-up in OpEx. Where is it coming from? Is it more on the R&D side, SG&A and maybe any changes to the size of the selling effort given new leadership?
Leigh Vosseller: Yes. So, the investments we are making in 2024 will continue to be similar to what we talked about in 2023, and it’s focusing on advancing our program. So, there is R&D investments to come as well as investing in our sales and marketing activities to make sure that we effectively launch these products this year. We are still generating savings, though, from a number of initiatives that have been underway primarily in our customer service and customer technical support organizations. Tandem Source is the foundation that allows us to continue to bring efficiencies in how we interact with customers. And so it can remove some of the requirement or need for having people on the teams available to answer phone calls 24/7. And so that’s something that we are going to continue to be focused on. This year is not really a year of margin expansion overall for Tandem though, and that’s mostly because of getting Mobi out the door and getting it to scale. But we do have our sight on leveraging in the future and meeting those long-term margin targets.
Jayson Bedford: Is this – are you increasing the size of the sales team?
Leigh Vosseller: It’s always under evaluation.
Jayson Bedford: Okay. Thank you.
John Sheridan: We are definitely looking at investing in the sales organization OUS. That’s one of the things we are doing, but U.S. is still under evaluation. We just – as you know, Mark Novara just joined the organization, and he is working with the sales leadership to evaluate that carefully for the U.S.
Jayson Bedford: Perfect. Thank you.
Operator: Thank you. Our next question comes from the line of Jeff Johnson of Baird. Please go ahead, Jeff.
Jeff Johnson: Thank you. Good afternoon guys. Maybe just two clarifying questions at this point in the call. So, Leigh, did you say that – sorry, renewals in the U.S. were up 50% or slightly above 50% for the year or for the fourth quarter?
Leigh Vosseller: For the year, they were up more than 50%, the shipments themselves.
Jeff Johnson: Okay. So, that – our math would put renewals probably pushing the upper 12,000, maybe even not quite to 13,000. I know you don’t give that number, but is our math for the fourth quarter renewal number somewhere in that 12,500 to 13,000 range, at least ballpark accurate?
Leigh Vosseller: I would say that’s a little on the high side, Jeff. I can help size up, I would guess, I would say, for the year, when you think about – we had about 50,000 opportunities for the year, and we said we renewed about half of them. Also, we still have people from years prior. And so as we think about, as John mentioned earlier, our renewal goal is 70%. So, moving the needle from that 50% to 70%, for instance, on that cohort from 2022 and it’s there on top of that. And so I am not going to really give you any specific color on Q4. Again, I would say that your number was a little bit on the high side.
Jeff Johnson: Okay. That’s helpful. That’s good enough. And then, John, you mentioned in the call that you expect the MDI competitive kind of percentages, 50-50, where it’s been quite a while. The competitive part of that number to go down going forward, I mean, one, how quickly and to what extent does that decline from the 50-50 mix that you have had? And I don’t know if I heard in the fourth quarter, was it close to 50-50, and you just expect that ratio to maybe shift going forward, or did it already start to move in the fourth quarter? Thank you.
John Sheridan: Yes. I mean I think that there is two things going on. One is we think we are going to be more successful penetrating the MDI conversions. So, more people are going to move to pump therapy, which is going to obviously make the MDI conversions a larger portion. At the same time, when you look at competitive conversions, the renewals for our competitors is also – the number of the installed base is dropping. So, I think that the available competitive conversions is dropping as well. So, I think that’s kind of the two dynamics. And I think it’s just one of those gradual trends we will probably start to see. It could be by the end of this year or early next year, it will be more meaningful.
Leigh Vosseller: And we can confirm, it did stay around the 50-50 market.
John Sheridan: Yes. I would say for the fourth quarter, but I think it’s something that we are going to see in time.
Jeff Johnson: Yes. That makes sense. Thanks guys.
Operator: Thank you. Our next question comes from the line of Joanne Wuensch of Citi. Please go ahead, Joanne.
Unidentified Analyst: Hi. This is Felipe [ph] on for Joanne. Just quickly on the competitive environment. It seems like some of your competitors are bridging the gap on AID offering. So, I am just wondering, have you seen – especially in the U.S., have you seen any pickup in competition from the two competitors. And then OUS, maybe one of your competitors is releasing a patch pump with an AID integration. So, I’m wondering if you are feeling anything there?
John Sheridan: Well, I mean I think I know which competitor you are talking about in the U.S. And I would say for us, at least, it’s kind of hard to parse their numbers. I think that – what were the pump starts last year, are they new pumps or updates? And so there is a number of things out there that really make it hard for us to figure out what’s going on there. I will say though that our U.S. competitor with the two pump has got a better product in the market. And I think as a result of that, they are doing a better job of retaining their own renewals. I would say that that dynamic has been relatively stable over the last two quarters. We absolutely saw an impact, but it’s been relatively stable. And I think that as we bring new products to market and they become more visible in the marketplace, we do expect to see competitive conversions grow as people become familiar with the enhanced wearability and choice of our portfolio. So, we think that it’s a timing issue with us. I mean I think that we are just getting started now in the introduction. I think in the second quarter or late spring when the – when X2 with – excuse me, Mobi with G7 is available, we will see an uptick from that, and I think we will see steady progress throughout the year. So, I think that – again, I think that our portfolio is going to help us just keep the competitive conversions in our favor this year. OUS, there is – we have been competing against the product that you are talking about in the U.S. We are very familiar with it. We think that Tandem still has absolutely the best AID system in the market. And we hear that from physicians. And I think that with the wearability options that we are providing right now and choice with sensors, we think that in combination with our AID system really does differentiate us here and in the OUS countries. And I will say that we are making a really focused effort to drive our portfolio and innovation and new launches OUS to be more effective competing against that market.
Unidentified Analyst: Great. Just following up on Mobi, I am wondering, like, any early signs of adoption? And then I know the integration with G7 is going to be a big turning point, I guess is that when you are going to really start to see some revenue contribution? Thank you.
John Sheridan: I mean I think the G7 integration is certainly going to help us. We are seeing very significant interest and excitement right now. It’s only been a week or so. I think that if you talk to the sales organization, they are very pumped up. There is a great deal of interest from the physicians in the marketplace. They are asking to come into their offices and see the product. They have heard about it. As I have said, we have had a number of HCPs. We are part of our early access program who have been speaking about it. And I think it’s going to be a big product for us. It’s going to exceed our expectations, I think. So, we are all very excited about it.
Unidentified Analyst: Thank you.
Operator: Thank you. Our next question comes from Alex Nowak of Craig-Hallum. Your line is open, Alex.
Alex Nowak: Okay. Great. Good afternoon everyone. So, any reason why Mobi didn’t launch with the G7 Libre 3 integration, and it did launch with G6 and Libre 2?
John Sheridan: Well, I think that we have a lot of experience with G6, and we tried to control the number of variables that we are introducing. We wanted to make sure the pump itself is performing as we expected to. And I have to say that it’s been incredible how well the system has performed in the market. So, it’s just a fast follow to get G7 onto it. And this was the intent all along. It’s not that far off now as we are just talking actually weeks or just maybe two months before it’s on the market. So, it’s – I think it was a strategy to make sure that we minimize the variables as the product came to market so we understood exactly how it performed.
Leigh Vosseller: And a point of clarification, Alex, it’s not yet available with Libre 2.
Alex Nowak: It’s not yet. Okay. That’s helpful. A lot of moving pieces with all the integration, so that’s helpful. And then when can we nail down the timelines with – whether it would be Mobi tubeless, t
John Sheridan: I think that we are going to be more cautious about discussing timelines for competitive reasons. And I think that we understand the need to have access to that information. So, I think as we get close and we are more confident in the availability and the specific timing, we will share those on future calls.
Alex Nowak: Okay. That sounds good. Thank you so much.
Operator: Thank you. Our next question comes from Joshua Jennings of TD Cowen. Please go ahead, Joshua.
Joshua Jennings: Alright. Thanks for taking the questions. John, I heard you just reference the early experience with Mobi and creating less of a differentiated or gap between tube and tubeless systems and the question basically is, would you have investors think that the Tandem is less reliant on the Sigi patch pump development program for out-year success, or any further follow-up on the comment you made, I think in your prepared remarks in one of your answers on just the size and footprint of Mobi could be more competitive with the tubeless options. Thanks.
John Sheridan: Sure. I mean I think when you look at the portfolio and the specific platforms, we think there is a – I mean there is a need for a patch pump, absolutely. There are people out there that probably would not wear a pump unless it is a patch pump. But we think that the flexibility that comes along with Mobi when it has a tubed and tubeless option as well as the wearability that it has right now, just with the adhesive patch, it’s – it gives people a lot more flexibility, and it almost – it mitigates that tube, tubeless discussion. I think that some people are going to want to wear as a tube pump at certain times in their day. And they are going to also want to wear it as a patch device. And so it gives you that added element of flexibility that either a completely tubed pump or a completely patch pump does it. And there are people out there that want that flexibility. And so I think that we feel the market research really has indicated that there is a need for the three and that when we have the three, we really do a much better job of addressing the various segments of use out there.
Joshua Jennings: Great. Thanks a lot.
John Sheridan: Thank you, Joshua.
Operator: Thank you. And that does conclude the Q&A portion of our call. That also concludes today’s conference. Thank you for participating. You may now disconnect.