The Beta Bionics team with us here today. We've got Mike, who's the Chief Product Officer, is gonna give us full timelines on PatchPump, right now. Sean, who's the CEO, and then Blake that does IR and probably a bunch of other things as well. So thanks so much for making the long trip over here. I'm sure that weather's much nicer than in San Diego. But, I do wanna start with that Q3 result, which was just exceptionally good. What are you seeing in the market in terms of adoption of your product? And, you know, I mean, you're getting to the point, you know, I had Tandem here earlier. You're almost to the point where you're getting the same number of MDI patients as they're getting.
Mm-hmm.
It's not quite there yet, but I mean, you're a few quarters into the launch. So what's resonating so much with your patients and with clinicians?
Yeah. Thanks for noticing that. A couple things though. One, our sales force is also quite a bit smaller. So from a productivity standpoint, we're really quite proud of that. That's the number one thing to remember, and then, wow, my second point completely eluded me.
Yeah.
Yeah.
Simplicity outcomes?
Oh, the actual answer to the question, right. Yeah. So I, I think that our, our contention has always been that nobody wants to do more, right? So people are certainly learning that. Yeah, iLet, in fact, has proven as more clinical data we have, more real-world evidence we have, you get quite good outcomes without a lot of work. So that's resonating. That's getting pushed out, broadly. And I do remember my other point. You know, it is still true that a lot of clinics in the, the U.S. are, are no rep clinics. They, they're closed to reps. What that really means is that they're primarily engaged in using things that existed prior to them closing their doors in 2020 with COVID. Why are they still closed? COVID's gone because they like not letting the reps in.
I understand that, but it's gonna have to evolve at some point, so the reason I bring that up is when you think about the clinics that we are able to get into, which is, you know, not, you know, not a tiny fraction, but, you know, in those, the productivity's really good. Does that make sense?
I mean, how much of the market are you not able to access at this point because of these closed-door policies?
Yeah. I don't have a good answer to that one.
Okay. I mean, I don't even know if you wanna throw a number out there. Is it 25% of them, or?
I don't.
Okay. All right. So what is, you know, of the accounts?
Not a zero number.
That you're, yeah. It's not a zero. But of these accounts that you're in, I mean, where are you at in terms of some of these patient percentages you're getting? Are you 50%-60% of their MDIs? I mean.
Certainly, in certain clinics, absolutely.
Wow. Okay. And it's a function of the ease of use, like getting those patients that were, you know, 10s and 9s and trying to get them down to 7? Or are you getting, you know, the newer patients that are, you know, pretty good at controlling their diabetes, but they're ready to go on a pump and, you know, I'm sure it's all of the above. But if you had to point to one, which one would it be?
Tough to point to one. And the reason for that is that, you know, when you look at our baseline cross-section patient cohort, it looks just like the cross-section of patients with type 1 diabetes in this country in regards to A1c, meaning we're getting everybody sort of equally, which is exactly what we would hope. Now, it skews a little bit high, and that makes perfect sense. Our median A1c is a little bit higher than the median in the country. Why? Because there are several good options at the lower end, and fewer at the higher end. So we do skew that way, but not much.
Got it. Okay. Excellent.
Pretty much is fine.
You know, and then I think you said 70% of your patients are coming from MDI. How's that breaking down between type 1 and type 2?
I mean, we also stated that, you know, roughly 25% or over 25% of our patients are coming from type 2. As a general rule, those are not gonna be pump patients.
Okay.
Not 100%.
Right.
But so you can do the math on that.
Okay. I see. How are you doing so well in type 2 without an indication? I mean.
Well.
I'm sorry to cut you off, Sean, but.
Not at all.
That's not quite insulin levels. It's close.
Mm-hmm.
But they have an indication.
I think there's an expectation that the indication is required for reimbursement, and that part's not true.
Yeah. That I agree with.
Right? Yep. Not, not the case at all. So when you look at the history of diabetes, I think it's always been the case that doctors are familiar with the tools they have at their disposal. They know what they do. They know where they work well, and they use them where they work. We don't sell in type 2, and turns out we don't have to. We, we simply explain to the doctor what the evidence that we have, our indications, what the product is, and they choose where to use it. That's what happens.
That fascinates me 'cause my mother-in-law's a type 2, and she cannot, like, her endo doesn't even know about the, you know, approvals. So that's amazing to me. Is there this chunk of patients that are, you know, tough to treat that are really where you're seeing a lot of your growth right now? And then, you know, in these, you know, different accounts that you're actually in, what I'm really trying to get at, like, do you have, like, kind of a ceiling of, you're really benefiting, you know, the first couple of years here in this tough-to-treat patient population, and then what? Or is that where.
Again, I.
More many?
I would point you back towards the data that shows that we're being used relatively equally across the entire patient population with type 1, and for us, the concept of tough-to-treat patient doesn't really exist because, you know, the product seems to work well if you're engaged. It seems to work well if you're not engaged.
Yeah.
You know, I think in our real-world evidence here, if we take our entire patient population and then limit it to people who are only giving less than one-half meal announcement per day, so less than one every two days.
Yeah.
Which on average is well less than that. I believe the data states that we're going from a median baseline A1c of 9.7% to a follow-up of 7.5%, a 2.2% drop.
Yeah.
In patients who are not bolusing.
Yeah.
Are those patients tough to treat, or do they just want a product like iLet?
Right. Yep. Yep. Okay. Can you get that? And maybe this is for Mike, but just, you know, the algo question. Can you get that group under 7? 'Cause that's the only thing I ever hear is like, "Well, you can't get under 7, you know, with iLet," which I'm sure plenty of patients are getting under 7. But can you get that group under 7? Is there a way to adjust the algo if you're not announcing meals, etc., for that point?
Yeah. About 50% of our population is under 7 currently. And we're excited about bi-hormonal as well, which the early feasibility data showed about 92% under 7.
Oh, wow. Okay. Okay.
I agree with Mike. That's our clinical trial data, is roughly 50% under 7 as well, which is a controlled-to-target system, target being about 7, right? There you go, and the clinical trial showed that when you come to us from competitive pumps, you drop your A1c about 0.3%. You know, I would question the,
Yeah.
The truth behind that statement.
Yeah.
It does get thrown out. It's competitive selling.
Sure. Of course. Okay. And so I typically, or actually, let me ask this question first, then I'll get to the one I typically ask Stephen. But 30% of your new patients are coming from competitive conversions. Are those primarily durable pumps? I think you said a third, a third, a third.
Third, a third, a third.
But it would just seem like the durable pumps would be much easier to get. Why would a patch pump person say, "Okay. I'm gonna try this?
Matt, you know, we've talked before about what I call the four pillars, right? The four decisions somebody might make when purchasing their insulin pump, and those are algorithm, form factor, CGM integrations, and channel, DME, or pharma, and let's talk about that first one, algorithm. There you go. First of all, there are people that prefer durable form factors. However, if they've previously chosen a patch form factor, they're likely not that person, but any of the rest of those could make the decision to push you back the other way, and in this case, I think we're primarily seeing algorithm. Simple fact is that the iLet algorithm is doing what others haven't been able to, and as I just mentioned, the clinical data states that when they come to us on average from other pumps, they're gonna see their A1c drop, so there you go.
Okay. And maybe before I get to Blake, just a quick question for Mike. Their, you know, insulin, just their investor day, they talked about a fully closed-loop system.
Mm-hmm.
You know, Tandem's talking about it now too. I think they've got some data around one. How different, like, well, first of all, when they talk about full closed-loop, is it gonna be as robust as yours? And then, you know, how can they do it? 'Cause I thought you had a really strong patent portfolio around the algo.
So in order to get the outcomes in a fully closed-loop, it's about the corrections controller being very strong, right? So we can't, you know, just modulate basal. We can't just correct once an hour. You need to give the insulin you need every five minutes in response to that meal, to get the insulin in quickly in order to get good outcomes. And that's exactly what iLet does. We published our real-world data around people that Sean mentioned, bolusing less than once every other day, and the outcomes are tremendous, you know, a 2.2% A1c reduction on average in that population. So I would challenge anybody to go against our current real-world data on people using it in that mode.
Okay. But what about from an IP perspective? Is it, is it also buttoned up to some extent?
Yeah. I mean, there's aspects of any algorithm that are gonna be patented, but, you know, there's always certain ways to circumnavigate IP.
Okay. Got it. All right. And so the question I always ask Stephen is wrong turn. So I'll ask you, Blake. You can shut me down on this one. But I don't wanna go there this time, but I'm just more curious on the retention rate you get between MDI and then competitive conversions. Is there a delta between the two, a meaningful delta, or are they pretty similar?
I love the fact that his only answer's gonna be no comment.
Yeah. Yeah.
Sorry. I just gave you a text.
He's not here now. I don't like you throwing that around me, but I'll say, "Yeah. We're not gonna comment on that.
Okay.
All right. Okay. All right. You can let him know I tried.
Well, yeah.
What about the pharmacy uptick in Q3? That was notable. Why are you going so or how are you doing so well there on the pharmacy side? You know, 'cause I think you almost doubled the number of patients that go through that channel compared to Q2.
Well, look, I don't wanna give the roadmap toward how to be successful in that area. I don't think we've ever expected that was gonna be a competitive advantage for us. We just knew that it was a business model evolution that two pumps needed. That being said, it's become a competitive advantage for the time being, and we'll take it. But what I will say is that, you know, Mike and I built Companion Medical, and that product was exclusively through the pharmacy channel. So it's a channel we knew really well. We knew insulin pumps really well. We knew, you know, and when you look at it, the DME space and the pharmacy space are almost completely different in all regards.
So all these things that we just know in DME, and then you say, "Oh, pharmacy's like this." Like, well, no, it isn't. You know, well, that would make sense to the DME expert. So you have to be prepared to question absolutely everything about the way it works because it's opposite.
Okay. Understood. It did look like pharmacy pricing fell a little bit in Q3, but I think that's related to the initial start. Is that the right viewpoint?
Stocking dynamic.
Stocking dynamic. So there was no pricing degradation. Okay. Okay.
Yeah. No, no pricing degradation. And, yeah, it was just a matter of destocking in the third quarter in the pharmacy channel relative to where mail order pharmacies finished in terms of inventory on their shelves at the end of the second quarter. So.
Okay.
It's not a retention problem. It's not a pricing problem. And I think Stephen walked through that pretty clearly on the earnings call.
First of all, thrilled that Blake got a question in there, but also wanna sorry, man. I'm kidding.
No worries.
Also wanna add that he, you know, used the phrase destocking, not intentional destocking.
Yeah.
Right? Just, you know, stocking dynamic. This is lumpy.
Yeah. He also answered the churn question too and said it's stable, so that's good.
Fair enough. All right. So.
That's two.
I'm kidding. I'm kidding. So what about the pricing in the pharmacy channel? I mean, I don't worry about insulin. They're priced similar to you guys, but.
Yeah.
I've been trying to triangulate on the numbers for Tandem, and it looks like they're charging like $250, maybe a little bit higher than that per month now for their disposables. Are you worried about seeing some price erosion as a result?
Tandem's pricing model is completely different than ours. They're still getting an upfront payment.
Yeah.
And, you know, and we don't get that upfront payment. So, I think you can expect that they're not going to, well, they're not gonna maintain that structure long term. I believe. Maybe I'm wrong.
Okay.
About that, but, it is a completely different model than what we're following.
But on the supply side, I'm assuming that theirs is probably cheaper than yours. Or is that something you worry about?
I don't know their pricing.
Okay.
I mean, I know what I've heard in the earnings call that they're intending to continue to get the upfront payment.
Yeah. Okay. Got it. All right. So when I look at, I think you're gonna add about 19,000 patients this year. That's my model. Roughly 30%. I know it's a little less than that through the pharmacy. You know, at $450 per month times 12, sorry, I'm giving you a ton of numbers. I get an incremental $31 million for 2026. I know you got some of that revenue here in 2025. You know, and those are gonna be some churn. But, you know, isn't, aren't we gonna get this massive pharmacy tailwind in place next year because you did so, so much better on the pharmacy side than expected?
Yeah. So here's the question. You know, we've spent a lot of time on earnings calls about pharmacy and using phrases like headwinds and tailwinds, you know, for a particular patient. And, I think people get a bit confused. They're like, "Let me get this straight. Every patient's a headwind for a while." Yeah. But who cares, right? What we really care about is when does it make sense for Beta Bionics to embrace the pharmacy channel, right? What day will we say our finances look better today than they would have.
Yeah.
If we'd have just continued down the road of DME? Let's assume that the sales are the same, right? Now, we think we have incremental sales from the pharmacy channel, obviously, but without that, the answer is, and this is roughly, right? You'll have to do your own models, but roughly, when we have three times as many people in the pharmacy channel as we add to the pharmacy channel in that quarter, at that point, the pharmacy patients overpower the, you know, the ones that are already in the channel. The tailwind from them overpowers the headwind from the new patients.
I see.
The pharmacy portion of our business looks better than the DME portion of our business. We're not there yet, but we're pretty darn close.
Okay. Got it. I mean, to that end, can you get your DME users over to the pharmacy? Can you push them that direction? I mean, they don't have to pay for a new pump. And how quickly can you do that?
You could. I'm not sure that it's the right thing necessarily.
Why is that?
These are people that got their product in DME at a particular price. It's, at some level, it's double dipping. There is a level. It naturally happens at some level, you know, as people move, insurance companies, etc. But to intentionally do it is, at some level, double dipping, in my opinion.
Yeah. Okay. Fair enough.
So.
What about the sales force? I know you've been adding to that group. You're still, you know, well below everybody else. But, can you talk about, you know, your new sales reps, their ramp? And are they going faster than the last cohort? I'm assuming so just because they've got better numbers.
I don't wanna talk about the individual dynamics of each class of sales rep, but yeah, we're, you know, we're a little lower than some of the other companies. And, you know, we're gonna continue to add, obviously, over time. We do get the question a lot, "Why are you not going great guns in your sales team?" And the answer is because we want really good salespeople.
Yeah.
Right? We're not only launching, you know, well, let me say this. We're launching a new category. In order to launch a new category, you need to know that new category and what it is. You need to know the old category and what it is. You need to know the differences and why those are a benefit. It's a harder sale. Ultimately, it becomes easier, right? But when you have to open up a new account, that's harder. You have to tell a doctor to think differently. And we wanna make sure that we get, you know, people that have a lot of diabetes experience, ideally pumps, if not that, then CGMs. If not, we'll talk pharma reps. But, you know, we're not gonna go out and get, you know, your average used car salesman and, you know, teach them about everything they need to know for diabetes.
So we'll be more deliberate than that.
Understood. Okay. And maybe this question's for Blake. I don't know why I'm throwing you all the financial questions, but, you know, there's all these tailwinds, right? You know, you've got pharmacy and, you know, a lot of growth and just your sales force is expanding, etc. I look at revenue estimates for the company. You're gonna increase incrementally on an absolute dollar basis, about $30 million this year. You've got all these other things going on that are positive for the company. It's recently modeling things up to $35 million for next year, absolute dollars. Just feel comfortable with that number? Feel that, "Hey, look, it's a good starting point, conservative, and we hope to do better." How do we think about that?
Yeah. I'm sorry to hit you with another kind of no-no comment type of answer, but.
No comment on that.
But yeah, we'll wait to comment on 2026 numbers on our following earnings call when we issue guidance.
Okay. Fair enough. What about Sequel and twiist? I know it came up a lot, like this time last year and even earlier this year at a lot of these meetings. Is it still something that you're hearing a lot about? It kinda feels like a failed launch. I mean, is that something to really worry about, you know, heading into next year?
We're not particularly worried about it. Look, let me be clear. There's nothing wrong with that product, and it's a good product. Certainly, Loop is a much-loved algorithm. To be clear, Loop is a much-loved algorithm by people who are willing to download code off GitHub, you know, download Xcode, become an Apple developer, download that code to their phone. Let me rephrase. Engineers. It's a very engaged algorithm, and it works great. But it is very much the opposite end of the spectrum from what we're doing. So we wish them luck. We wish them the best, in fact. But, you know, we'll take the other end of the spectrum, people who wanna do less, not more.
Got it. Okay. All right. And so here's the question that I'm really curious about, and I love how defined you guys are about this, but you know, you said that you started your patch pump project in December of 2023. I can remember in 2008, Medtronic showing us their patch pump. I'll never forget that investor day. So we're two years later at this point, and you're talking about approval probably sometime next year. I wanna put words into your mouth. I know you're a product genius, Sean, and like, you guys are phenomenal, but how the hell did you do this? And what gives you the confidence that you've kind of accounted for all these things that others have gotten wrong?
Do you want to know? Sure. So, you know, iLet, we had to build the algorithm, the pump, get the entire system approved along with the clinical trial, human factors study. Fortunately, this one is just a pump, right? We already have the algorithm. We're just porting that, and the FDA has done great work to modularize the components of the system. So we're really focused on just an ACE pump approval. So with that, of course, it's not simple. We have to build, you know, the entire design. We have to validate it through human factors. We have to do all the bench testing and submit the 510(k). And then we have to scale manufacturing. So it is a challenge. I don't wanna underplay it at all, but, you know, we're a company with tremendous focus.
We have a clear product vision, so we know what we want. We know the characteristics of the product. We don't waffle on various product decisions. We don't place multiple bets on different patch pump options. We define the best product, and the team is very, very focused to go after it.
Okay.
And with that, with that relentless focus and execution and minimizing distractions within the R&D group, you can do tremendous things in short timelines.
Right. I know you guys all sit close together, and you're involved in everything, but still, what is it that you figured out? I mean, I get the algo, and you've got that figured out, and it's great. It took forever to develop the algo, and iLet, for that matter. But there's a lot of other componentry that goes into a patch pump.
Mm-hmm.
To get it to work and be safe every single time out of the box.
Mm-hmm.
What did you figure out, you know, componentry-wise or design-wise that others have not?
Yeah. Remember, we built a pump, launched a pump before.
Yeah.
So we understand accuracy.
Got it.
We have an accuracy lab. We have all, you know, occlusion testing. We have all the protocols and test methods in place that had to be modified to fit this particular product, but we've done it all before.
Okay.
It's really just about miniaturizing it, and getting it to work in the small form factor. It is a lot of work, but, you know, that's, that's where the innovation goes.
I think.
It helps our CEOs and mechanical engineers as well.
Yeah. Okay.
I didn't design it, but, you know, what I hope is a core competency of ours is to make decisions quickly. To your point about me being involved in everything, that's not really true. I wish I was, but when we do have a holdup and we do have something that we were not sure which way to go, I will make a decision, and we will go, and we're not gonna spend, you know, 12 months doing market research on that question.
Yeah.
I probably get it wrong a lot of the time. Fine. I'd rather be wrong with the product in the market and let the market tell me I was wrong. We'll fix it.
Yeah.
But, you know, you do watch most companies get absolutely paralyzed because people are afraid of being wrong, right? Because you get fired for being wrong.
Right.
I guess I'm not afraid of that.
Okay. Understood.
Maybe that's dumb.
Yeah, no, no. So I guess, you know, end of 2027, for the revenue there, full, that means like full launch at that point, right?
Unconstrained launch is the phrase I've used.
Got it.
In the Q2 earnings call, which I just mean that we'll, it's just that. We'll be able to support the demand that we anticipate having at that stage. If the demand is far greater than we anticipate, maybe not, but that's it.
Okay. And approval sometime next year, limited market release while you're scaling manufacturing, and then broader release in 2027. Is that the full unconstrained release?
That was really well done to get a no comment.
Okay. Should've passed it off to Blake then. Okay. All right. And then, you know, something else that we've, that's come up, and you and I have talked about this, is that the cannula is a steel cannula.
Yeah.
We were listening to, actually, Sean was listening to a podcast the other day, and the guy was actually saying, like, "This is actually a good thing because it'll get through scar tissue because people wear things in the same spot a lot.
Yeah.
How do you respond to that, "Oh, it's a steel cannula. It's gonna hurt? It's gonna hurt when you place it. It's gonna hurt when you're wearing it.
All, you know, today we have steel infusion sets. They're actually much loved. They don't hurt. They don't occlude. They work great.
Yeah.
There was a marketing push the other direction a while ago. It's not actually true. The cannula that we use is the same thing as a, you know, 31-gauge insulin needle.
Okay.
Like, find me the person who took their insulin needle when they used the new one. Most people don't, you know, and injected it and went, "Ow." You'll never find it because you don't feel that. You know, I, I think the, I can argue all day long why it's the right choice, but the reality is you gotta wear it.
Yeah.
Like, holy smokes. And when we do this, and, you know, we put competitive products with our product on people simultaneously, and it's like, "Yep, there you go.
And then you're.
A little better about that.
Gonna have, where you don't have to pair it every time, right?
Right.
'Cause that's another, like, key update that we've heard about. Are other products gonna be able to do that as well, or are you gonna be alone as far as just the pairing option?
Every product has its own product decisions, and there's a lot of aspects of it, but we looked at the entire journey of changing the patch, which was really the interaction with the hardware itself.
Yeah.
Other than, you know, the great algorithm benefits of not having to do manual corrections anymore, not counting carbohydrates, but in the actual patch change, which happens every three days, roughly, we wanted to remove every step possible, you know? So pairing to your phone only has to happen once per year or every two years. You know, carry your CGM pairing from patch to patch. You confirm or update once. You don't have to firmly either wait for updates to come out from the manufacturer or even do one every single patch. There was a lot of decisions that we wanted to simplify.
Okay.
When I think you actually stack it up next to each other, we're gonna find we're the simplest product out there.
Got it. Okay. Just a few seconds left. How do we, again, you guys are kind of just, you know, kind of, you're completely disrupting this market. You're disrupting it on the profitability side too. How do we think about your path to profitability versus, you know, MiniMed, where they got acquired versus, you know, Tandem, etc., that path to profitability?
That's a tough one with four seconds left, but we're committed to making that a hell of a lot faster than is traditional in our industry. You know, if our history is any teacher, then we'll be able to do that.
Do that. Got it. All right. All right. We're out of time. I'll wrap it there. Thanks so much for the answers and the non-answers, really, group.
I'm very welcome.