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Good morning, and welcome to the Insulet Corporation first quarter earnings call. As a reminder, this conference call is being recorded. I would now like to turn the conference over to your host, Clare Trachtman, Vice President, Investor Relations.

Good morning, welcome to our first quarter 2026 earnings call. Joining me today are Ashley McEvoy, President and Chief Executive Officer, Flavia Pease, Chief Financial Officer, and Eric Benjamin, Chief Operating Officer. On the call this morning, we will be discussing Insulet's first quarter results along with our financial outlook for the second quarter and full year 2026. With that, let me start our prepared remarks by reminding everyone that we will make forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements are based on current expectations and assumptions and involve risks and uncertainties that could cause actual results to differ materially. Please refer to today's press release in our SEC filings, including our most recent Form 10-K and Form 10-Q, for a discussion of these risks. We undertake no obligation to update any forward-looking statements.

In addition, on today's call, non-GAAP financial measures will be used to help investors understand Insulet's ongoing business performance, including adjusted gross profit, adjusted operating income, adjusted EPS, free cash flow, and constant currency revenue, which is revenue growth excluding the effect of foreign exchange. Reconciliations of the non-GAAP financial measures being discussed today to the comparable GAAP financial measures are included in the accompanying investor presentation and are available in our earnings release issued this morning, both of which are available on our website. Additionally, unless otherwise stated, all financial commentary regarding dollar and percentage changes will be on a year-over-year reported basis, with the exception of revenue growth rates, which will be on a year-over-year constant currency basis. During the Q&A session this morning, Ashley, Flavia, Eric, and myself will be available to address any questions. Now I'd like to turn the call over to Ashley. Ashley?

Thank you, Clare. Good morning, everyone. We're pleased to report a strong start to 2026 with continued growth momentum, robust margin expansion, and disciplined execution of the strategic priorities we shared at Investor Day. Our first quarter performance clearly reflects the opportunity in our large and under-penetrated markets, the strength of our differentiated technology and compelling clinical outcomes, the scalability of our recurring revenue business model, and the deep expertise and commitment of our teams around the world to finding a better way for people living with diabetes. We also made notable progress on our strategic priorities, which are to accelerate innovation that improves outcomes and unlocks new segments, develop our core markets as the category leader, strengthen our commercial capabilities, build a world-class team to enable our growth ambition, and leverage our financial strength to invest in and scale our business profitably.

In the first quarter, we achieved 30% revenue growth, including 28% in the U.S. and 45% internationally. We continued to expand our customer base through new customer starts and enjoyed strong retention and loyalty among our Podders globally. Leveraging our strong revenue growth, we expanded adjusted operating margin by 110 basis points year-over-year. Adjusted EPS growth of approximately 40% was driven by our robust top-line growth and margin expansion and the benefits of our first quarter share repurchase. This performance reinforces our confidence in the financial growth algorithm we laid out last year and in our strategy to capture the significant opportunity ahead of us as the market leader and primary driver of category growth in the fast-growing global AID market.

As a result, we are raising our full year 2026 total company revenue growth guidance from 20%-22% to 21%-23%. Flavia will share more details on our performance and outlook shortly. Let me first walk you through how we are developing our key markets, driving performance, and advancing our strategic priorities. Starting with the U.S., our growth this quarter was strong, reinforcing our market leadership. We grew new customer starts year-over-year, led by strong momentum in AID adoption for Type 2, and benefited from positive pricing. We did experience greater than normal seasonality, which we believe was driven by the annual reset of deductibles impacting patient co-pays and co-insurance. These factors contributed to what appears to be a slower start to the year across the U.S. diabetes category.

Improving month-over-month trends over the course of the quarter and into April suggest this was a temporary headwind, and we remain confident in our U.S. outlook for the full year. Our upcoming integration with the FreeStyle Libre 3 Plus sensor this quarter will unlock the benefits of Omnipod 5 for the nearly 450,000 people with diabetes currently using the FreeStyle Libre 3 Plus sensor. In U.S. Type 1, we continue to extend our leadership and drive increased penetration, with solid growth in our customer base both annually and sequentially. Commercially, we are upskilling our sales force to strengthen our messaging on clinical performance in the field, and we're deploying tools to optimize physician targeting and conversion while expanding reach and frequency. I remain confident in the opportunity to continue to move people with Type 1 diabetes from MDI to AID and drive increased penetration.

In U.S. Type 2, we continue to expand the category and accelerate adoption from those using MDI. As expected, our Type 2 customer base grew rapidly over the prior year, supported by our prescriber education initiatives and the ADA guideline update, which established AID as the standard of care. We remain confident in the trajectory for U.S. Type 2 AID adoption and in expanding our market leadership position. Notably, Omnipod's first-mover advantage gives us a head start in understanding the nuances of this market and in designing targeted initiatives to eliminate the barriers for adoption. For example, access and affordability are even more important for adoption in Type 2 than in Type 1. In fact, our ongoing efforts to increase access and remove prior authorization requirements generated a 4% net access improvement in the first quarter, benefiting an additional 16 million lives.

We continue to see a vast opportunity to bring meaningful improvement in both clinical outcomes and quality of life to the millions of people with Type 2 diabetes. Moving outside the U.S., our international business delivered another standout quarter, driving significant profitable growth and recording our third consecutive quarter of growth above 40%. We achieved 45% constant currency revenue growth, supported by continued strong year-over-year and sequential growth in new customer starts, as well as positive price mix from the ongoing conversion from DASH to Omnipod 5. We are generating robust growth across our largest and most established European markets, including the U.K., France, and Germany, all of which delivered strong first quarter new customer starts, driven in part by our focus on new prescriber activation. In the U.K., we achieved record NCS three years into our launch, reflecting the success of our strategy to deepen penetration internationally.

We also continue to expand access and reinforce the value of Omnipod 5. In Canada, for example, we secured improved reimbursement and new coverage for Omnipod 5 across four provinces, further fueling our growth. We now have reimbursement approval for 85% of the Canadian market. Looking ahead, we remain on track to launch Omnipod 5 in Spain in the second half of the year. Spain has more than 200,000 people with Type 1 diabetes, a high rate of CGM adoption, and one of the lowest levels of AID penetration in our European markets. In the second half of this year, we plan to launch FreeStyle Libre 3 Plus in Germany and Canada, allowing us to bring Omnipod 5 to new populations as FreeStyle Libre 2 Plus is not available with a pump in either of these markets.

Critically, our rapidly growing scale internationally continues to drive operating leverage and significant margin expansion. Our strategy to deepen our penetration in our largest and most established markets is working, and our execution continues to exceed expectations. We continue to see the AID category expand globally. While our success is attracting competition, this further validates and raises awareness of AID and Omnipod, the most recognized brand in the category. We believe this dynamic is good for the category and good for Insulet. We are uniquely positioned to meet that worldwide demand at scale, and we are investing in accelerating innovation, strengthening our commercial capabilities, developing our markets, building a world-class team, and scaling our global operations to ensure we continue to benefit disproportionately from category growth. Let me unpack these priorities further.

Innovation remains the core driver of our growth strategy, beginning with this year's launch of our second generation algorithm, coupled with our Libre 3 Plus sensor integration and the broader rollout of Omnipod Discover, our new data insights platform. First, let me walk through the specific improvements behind the meaningful Omnipod 5 algorithm enhancements we're launching this quarter. In our simulated analysis, switching the target glucose setting from 120 milligrams per deciliter to our new 100 milligrams per deciliter option delivered an approximately 5% improvement in time and range. This is better performance through a simple setting change with no added user burden. Additionally, we improved the algorithm performance, so it now increases the amount of time users spend in automated mode with fewer interruptions during extended high glucose events. This has been a pain point for prescribers and podders.

We are pairing these two launches with an increased focus on clinical education to ensure prescribers understand the strong clinical efficacy and safety profile of Omnipod 5. Algorithm innovation will continue to be a key R&D focus. In fact, we are increasing investments this year to advance our next generation of products. We are making strong progress on our sixth generation Omnipod paired with our third generation algorithm, which is planned to launch in 2027. We are sharing data from STRIVE, our Omnipod 6 pivotal study at ADA in June, which will demonstrate continued improvement in automation and clinical outcomes.

This gives us confidence in the durability of our market leadership. Next up is our transformative approach to unlock the Type 2 diabetes segment. We are making progress on what we believe will be the first of its kind truly fully closed loop system for people with Type 2 diabetes.

We're encouraged by the results from our feasibility study that we presented at ATTD, which highlighted 68% time and range with no boluses. I'm very pleased to share that just last week, we enrolled our first participant in EVOLVE, our pivotal study to support FDA filing next year and launch in 2028. These new product investments are designed to help us deliver better outcomes, enhance the user experience, and unlock new market segments, accelerating the shift to simpler, more intuitive insulin delivery and extending our leadership. We also recognize that as this category grows, innovation alone is not enough, and we are investing in building a top-notch team and commercial capabilities to expand the AID market, fortify our competitive position, and drive rapid adoption. As part of that effort, we've recently appointed Mike Panos as Chief Commercial Officer to lead our global commercial organization.

Mike brings a proven track record of building and scaling world-class sales teams, driving market expansion, and delivering sustained double-digit growth across leadership categories. Our investments in our brand are also delivering unique commercial value. We have the most recognized brand in the category, which continues to bring in new users and generate traction with prescribers that our sales force doesn't actively target. We regularly activate our number one brand to increase category and brand awareness, and this quarter, Omnipod's feature appearance on the TV show Scrubs was a resounding success at raising awareness and amplifying representation. After the show, our inboxes were flooded with stories about how meaningful and moving it is to see people with diabetes show up like this, living their lives daily with ease.

These moments also drive action, like Michelle, who has Type 1 diabetes and reached out to one of our support specialists online after watching the episode. Michelle had a script for Omnipod written three years ago but never moved forward. With this nudge, we successfully re-engaged her and got her started on Omnipod. Market development remains a top priority. In addition to the progress on market-specific initiatives that I highlighted earlier, we are seeing strong traction with our global KOL engagement and professional education efforts. We doubled the size of our U.S. peer-to-peer education program in 2025 and expanded it by more than 50% year-over-year this quarter. In Spain, we are investing in key opinion leader education well ahead of the advance to accelerate adoption.

As I mentioned earlier, our efforts to improve access, secure new coverage, and strengthen our value to payers are yielding tangible benefits to our growth and sustaining our market-leading U.S. coverage of over 90%. These efforts also support the maintenance of our preferred position in the pharmacy channel amid increasing competitive activity, which validates the value of our pioneering pharmacy pay-as-you-go model. Notably, based on the pricing activity we have seen in this channel to date, we continue to expect rational and disciplined pricing and rebate behavior. We remain focused on educating payers on the clinical and economic value of Omnipod to ensure broad, high-quality access in all markets. Finally, scaling global manufacturing and operations continues to be a priority. We remain focused on quality, reliability, and customer safety.

Our team rapidly responded to execute the voluntary Medical Device Correction in March and implemented targeted fixes for the applicable manufacturing process. Manufacturing disposable, sophisticated electromechanical devices at consumer scale and medical quality is a complex process. We continue to believe that our ability to meet the unique manufacturing demands of tubeless AID remains a source of strategic and financial advantage. We have market-leading gross margins driven by our ongoing manufacturing productivity improvements. We continue to ramp our capacity and automation investments in Acton, Malaysia, and Costa Rica to support future growth. In summary, we are executing on each pillar of our strategy, accelerating innovation, developing our markets, strengthening commercial capabilities, building a world-class team, and scaling global growth profitably. Omnipod continues to be the market leader and the disproportionate driver of AID category growth in the U.S. and abroad.

Our investments are focused on extending our leadership by deepening differentiation across our platform while continuing to lighten the burden for people living with diabetes. Our strong results this quarter are testament to the strength of our position, our execution, and our attractive recurring revenue business model. I remain confident in our outlook for the year, our strategic path forward, and our ability to deliver sustained profitable growth for shareholders and better outcomes for all of our Podders. With that, I'll turn the call over to Flavia.

Thank you, Ashley, and good morning, everyone. As Ashley highlighted, the Insulet team delivered a strong start to the year. First quarter total revenues of $762 million increased 34% on a reported basis and 30% on a constant currency basis. Total Omnipod revenue grew 33% on a constant currency basis. In Q1 of 2026, our global customer base grew nearly 25% year-over-year, driven by increased adoption of Omnipod 5 across both the U.S. and international markets. Global new customer starts also increased versus the prior year period, with growth both in the U.S. and internationally. MDI conversions continue to be the primary source of new customer starts, and we expect this to remain the case given the significant under-penetration across our core markets, including U.S. Type 1, U.S. Type 2, and international Type 1 diabetes.

Globally, utilization and annualized retention rates remain similar to the prior year period. Now turning to our performance in greater detail. U.S. Omnipod revenue grew 28% in the first quarter, exceeding the high end of our guidance range, driven by continued demand for Omnipod 5 across both Type 1 and Type 2. The quarter included a benefit of approximately $10 million in revenue related to the timing of certain distributor orders, which we expect to be consumed in the second quarter. Excluding this impact, underlying U.S. revenue growth was approximately 26% coming in at the high end of our guidance. First quarter U.S. new customer starts increased year-over-year, but declined sequentially. As Ashley noted, we attribute the sequential decline to seasonality driven by the annual reset of deductibles, which impacts patient co-pays and coinsurance.

This effect was less evident in 2025, given that we were in the earlier stages of the Type 2 launch. Importantly, we saw U.S. new customer starts ramp through the quarter, and that momentum has continued into the second quarter. International Omnipod strength continued in the first quarter, with revenue growth of 59% on a reported basis and 45% on a constant currency basis. Volume remains the primary driver of international Omnipod growth, supported by customer expansion across both established and newly launched markets, along with favorable price mix benefits from the transition of DASH. Continuing down the P&L, our first quarter GAAP gross margin was 69.5%. It included approximately $12 million of expenses associated with our medical device correction. Our adjusted gross margin was 71%, down 90 basis points year-over-year.

During the quarter, we incurred some increased excess and obsolescence costs as we transition to new Pod configurations that position us to support Libre 3 Plus sensor integration and upcoming algorithm enhancements. These costs negatively impacted adjusted gross margin by more than 150 basis points. After adjusting for this impact, gross margin performance in the quarter was driven by strong top-line growth, continued manufacturing productivity gains, and positive pricing. Turning to OpEx, we continue to invest with intention to both maintain and expand our leadership while remaining disciplined in how we deploy capital. During the quarter, we ramped R&D investments to support our innovation roadmap and advance key clinical development programs, including Omnipod 6 and fully closed loop for Type 2. These investments position us to continue delivering meaningful innovation over the long run.

We also increased SG&A investments as we continue to prioritize market development initiatives to unlock AID penetration and demand generation efforts. We expect to continue ramping investments in sales and marketing as we expand our sales force during the second quarter and prepare for upcoming product launches, including FreeStyle Libre 3 Plus integration and our latest algorithm enhancements. These investments expand our commercial capacity, broaden HCP coverage, and enable us to drive additional new customer starts. First quarter adjusted operating margin expanded 110 basis points to 17.5%, driven by strong top-line growth and SG&A leverage. Our financial strength allows us to continue to invest for future growth while delivering margin expansion.

First quarter net interest expense was $9.8 million, an increase of $11 million, primarily driven by our prior year debt refinancing activities and lower interest income. Our first quarter adjusted tax rate was 19.8%, reflecting a benefit from US R&D tax credits and a favorable mix of earnings. First quarter adjusted EPS was $1.42, up approximately 40% from $1.02 in the prior year period. We're well-positioned to continue driving strong earnings growth, reflecting the strength of our durable recurring revenue model, our compelling top-line trajectory, and the operating leverage we are generating. Turning to cash and liquidity. During the quarter, we repurchased approximately 1.25 million shares for $300 million.

We ended the quarter with $480 million in cash and the full $500 million available under our credit facility, and we generated approximately $90 million in free cash flow in Q1, reflecting our strong operating performance in the quarter. Now turning to our outlook for the second quarter and full year 2026. For the second quarter, we expect Omnipod revenue to grow 21%-23% and total company revenue to grow 20%-22%. On a reported basis, foreign currency is expected to contribute approximately 100 basis points of benefit to both growth rates. In the U.S., we expect Omnipod revenue growth of 18%-20%. This guidance reflects approximately $10 million of revenue that shifted into the first quarter, creating a 200 basis point headwind to second quarter growth.

Internationally, we expect Omnipod growth of 28%-30%. While growth remains strong, as we discussed last quarter, we expect the pace to moderate as we anniversary successful launches from last year. On a reported basis, foreign currency is expected to provide a favorable impact of approximately 200 basis points on international growth. Turning to our full year 2026 outlook, we now expect total Omnipod revenue growth of 22%-24% and total company revenue growth of 21%-23%, reflecting our strong start to the year. We expect foreign currency to provide a favorable impact of approximately 100 basis points for the full year. For US Omnipod, we continue to expect our revenue to grow 20%-22%. We expect year-over-year growth in U.S. new customer starts for the year, positive pricing, and similar utilization trends.

We do expect retention rates to decrease modestly as our Type 2 customer base continues to grow, which is why we're investing in programs focused on improving onboarding, engagement, and long-term retention. For international Omnipod, we now expect 2026 revenue to grow 26%-28%. On a reported basis, we expect a favorable impact of approximately 300 basis points from foreign currency. We expect year-over-year growth in international new customer starts for the year as we penetrate further in current markets and expand Omnipod 5 into new markets. Omnipod 5 is now available in 19 countries, and we will continue to broaden our reach and plan to enter Spain in the second half of 2026. While volume remains the primary driver of our international revenue growth, our guidance also reflects a benefit from positive price mix realization as customers continue to transition from Omnipod DASH to Omnipod 5.

Overall, our international growth guidance assumes similar utilization levels and improved retention for 2026 relative to 2025. Turning to 2026 operating margin. We continue to expect approximately 100 basis points of operating margin expansion for the full year, driven by strong top-line growth and ongoing gross margin expansion while funding a meaningful step-up in R&D and continued investments in sales and marketing offset by leverage in G&A. I would note this outlook reflects the E&O costs we absorbed in the first quarter, as well as incremental raw material and shipping costs driven by the ongoing conflict in the Middle East. Looking at a few items below our operating income. We expect 2026 net interest expense to total approximately $40 million, an increase of approximately $15 million, primarily due to lower interest income.

We now expect our 2026 non-GAAP tax rate to be in the range of 21%-22%, reflecting the lower Q1 tax rate, favorable mix of earnings, and improved utilization of foreign tax credits. Based on these factors, we continue to expect adjusted EPS to increase by more than 25% in 2026. We expect free cash flow to be approximately flat from 2025 levels, supported by robust growth and continued margin expansion, partially offset by a ramp-up in capital expenditures to support our continued global manufacturing expansion plans. To close, we're executing against a clear framework focused on delivering top-tier growth, margin expansion, and increasing free cash flow. This approach underpins durable long-term value creation while enabling us to expand access to Omnipod for people living with diabetes worldwide. With that, operator, please open the call for questions.

Thank you. We will now begin our question-and-answer session. I would like to remind participants that this call is being recorded, and a digital replay will be available on the Insulet website. Please help us respect time by limiting to one question and one follow-up. The speakers available for Q&A today are Ashley McEvoy, Flavia Pease, Eric Benjamin. If you have a question at this time, please press star, then one on your touch tone telephone. If your question has been answered or you wish to remove yourself from the queue, please press star one again. In the interest of time, we ask that you please limit yourself to one question and one follow-up. You may rejoin the queue if you have additional questions. Our first question comes from David Roman from Goldman Sachs. Please go ahead. Your line is open.

Thank you. Good morning, and appreciate your taking the questions here. Maybe I'll just start with a strategic one and then go on to the financials. Ashley, I think you've been in the role now just about a year. Maybe you could help frame the past year, some of your observations here. What's gone in line with your expectations? What's gone better? Where are the areas where you're focused, and how are you kind of framing Insulet now that you've been in the role 12 months?

Yeah. Thank you, David, for joining. It was just last week, I marked my one year, and I would say that I'm absolutely more confident now than Insulet's potential than a year ago. You know, you know us really as this high-growth med tech innovator, doubling revenue over the past couple of years. I would say first and foremost, I'm preserving what makes us so special. It's this culture is remarkable and patient-focused, entrepreneurial spirit, and really strong competitive moat. Really just focusing around how we enhance our capabilities to really double the business once again. Maybe it's just helpful to share some of the areas that we've been getting after as a team to unlock more value. I would first start with innovation, and this is about doing things in parallel and at pace to continue our role as the tech leader.

Let me give you examples. It's really about being first in line to integrate day one with sensors like we're doing with the Dexcom 15 day, and we will do with Abbott's upcoming dual analyte sensor. Algorithms. You know, David, we were slow out of the gate continuously to improve our algorithms. We've addressed that now, and we have three algorithm improvements over the next three years. Second is really about international and driving profitable growth globally. I'm a big believer in going deeper in core markets that matter most versus going broader at this stage. The U.K. is a great example of this. We're several years in the OP5 launch. This quarter, we posted record NCS. The third is about our commercial engine and being famous not just as a tech leader, but as a commercial engine.

We have our second sales force expansion we've done in the past 12 months. It's happening this quarter. As I've been consistently saying, it's really upskilling our force to sell clinically. The fourth is really about strengthening our unbelievable foundation on operations as we scale globally. Costa Rica is a really good example of this. We just put in the foundation this quarter. We'll be ready to have a watertight building by year-end and go live in 2029. Obviously, it's all about people. You know, I came here, and there was a remarkably talented team, and I'm just supplementing that team with some new leaders that have run bigger things and know how to scale. Collectively, you know, we can get after doubling the business again.

You know, this is what gives me confidence that we're gonna continue to grow the category, serve more Podders, and really importantly, continue to increase our earnings power. You had a second question, David?

Yes. Thank you. Appreciate all the perspective there, and that does kind of segue to my second question. If you take kind of Q1 performance from the second quarter guidance into consideration, the outlook implies kind of high teens growth in the back half of the year. Can you help us unpack that a little further on a geographic basis and your confidence into the 20% LRP guidance as you exit 2026 potentially below that level? Maybe perhaps there's some conservatism in the outlook given the timeline where we are in the year.

David, good morning. It's Flavia. I'll take that one. To your point, yes, the midpoint of the guidance will imply second half growth in the high teens%. I would first start by saying we're still seeing very, very strong performance in both the U.S. and internationally. As you saw, we just raised our guidance for international and the total company right now. Last year, you asked me to unpack between the two regions. In the U.S. last year, we saw the opposite impact with comps playing a role in how this year, first half, second half, compares to last year, first half, second half.

In international, we're gonna continue having a favorable impact of price mix realization, but it's gonna be at a more moderate pace as we increase penetration of Omnipod 5 in our international markets. So when we look at the comps, I do think it's also important to look at dollars of growth. When you look at this year in total year, we're actually gonna be in line at the midpoint of the guidance with the same level of dollar growth that we delivered last year. The first half, second half is going to be different, but the primary driver of that is actually currency. If you look at that and look at the numbers on a constant currency basis.

We had you know the currency playing a role in the second half of 2025 that was a tailwind and the first half of 2026 again as a tailwind. So when you adjust for those things, the first half, second half phenomena gets a little bit more smooth, I would say. But importantly, let me close where your question was leading to, which is how does this play out in terms of our outlook for next year and beyond that we share with all of you at the LRP. On the sustainability of our 20%, we feel very very confident in our ability to drive that 20%. What gives us that confidence are the innovation and commercial catalysts that we're gonna continue to execute.

This year we're launching Libre 3 Plus, which as you saw in our prepared remarks, expands our TAM by another 450,000 people with diabetes. We have the algorithm enhancements. Ashley talked about the ones we're launching this year. We're gonna continue with Omnipod 6 next year, and then fully closed loop in 2028. Then commercially, in addition to, you know, leaning further on selling clinically and competitively, Ashley also just mentioned that we're gonna be expanding our sales force this quarter. As you can imagine, the full benefit of that expansion is really only gonna be felt mostly next year. We do see that as another tailwind. Internationally, similarly, those new product introductions are also gonna have a benefit. We're gonna launch L 3, Libre 3 Plus in Germany and Canada.

These are two markets where there's no Abbott sensor, and that are compatible with our product. That again is another expansion of our serviceable market. In addition to that, we're gonna continue to execute on our playbook of increasing access. You saw us just get the benefit of that for Canada this year with expansion of coverage in additional provinces. We just launched in the Middle East. We're gonna be launching in Spain in the second half. Again, we feel very, very confident that we have the right innovation and commercial levers to continue to support the 20% growth that we put out.

Thanks, Flavia.

Our next question comes from Robbie Marcus from JPMorgan. Please go ahead. Your line is open.

Oh, great. Thanks for taking the questions and apologize for the background noise. I'm on a plane right now. I want to follow up on that last question. Flavia, as we think about similar dollar growth this year, you know, that does imply deceleration as the sales base gets lower. You did mention you're gonna be exiting sub 20% in the U.S. in the second half this year. I think the question a lot of investors have is how do you maintain that 20% growth rate over the LRP if you're decelerating into year-end and dollar growth is not increasing year-over-year. Maybe just fill us in on the gaps about 2027 and how that improves. Then I have a follow-up.

Robbie, I think, going back to what I just articulated, we will continue to drive the 20% with the innovations that we're launching. In 2027, we do have Omnipod 6 and the full benefit of the sales force that we're expanding this year, that will be a tailwind.

I mean, Robbie, just maybe what's helpful is kind of our philosophy of how we set guidance. You know, a year ago I came in, and we got the team together. We refined our strategic plan. We racked and stacked a whole portfolio of growth opportunities, and this led us to really a strengthened conviction in the unmet market opportunity. Flavia was talking about the high TAM, low penetration, and quite frankly, our proven track record of unlocking that growth. So this led us to really raise our ambition as a company, which we shared at our IR day, which is the first one we've done in 10 years in November. We shared our strategies, our financial algorithm, and then we set our financial targets accordingly.

Our goal is to outperform, and our quarter one results reflect this along with our increasing full year outlook for the year. This is just really good momentum, and it gives us confidence in our commitments that we shared at our LRP.

Great. Maybe a quick follow-up. You talked about a slowing market on seasonality and new patient starts in first quarter. I guess two parts. One, what do you think the market grew? I know it's hard to give an answer without everybody else reporting yet, but what do you think it grew? Why was it more seasonal than usual? How do you think your new patient starts U.S. NCS did in first quarter?

Well, I obviously don't have the metrics. I mean, the market size, I would tell you 2024 and 2025 at an accelerated rate versus prior years. We're encouraged with the continued momentum. Listen, quarter one started off slow, you know, because we had higher than usual quarter one seasonality. We attribute this to the reset of deductibles and potentially the ACA transition. Sequentially every month we've been getting better, and I feel really good coming out of April as we look to quarter two and for the full year.

Our next question comes from Travis Steed from Bank of America. Please go ahead. Your line is open.

Hey, I wanted to ask about the Type 2 retention comps. Just kind of curious what you're seeing there. You know, why kind of call out slowing and then when you think about kind of the Type 2 opportunity is kind of this next kind of 5-10 points of the penetration curve, you know, going to be harder to get from the first few points like that you've got over the last year? Just kind of curious how the Type 2 ramp is going.

Yeah. No, thank you, Travis. I mean, our Type 2 momentum remains strong. Our new customer starts in Type 2 grew meaningfully both year-over-year in the quarter despite this Q1 seasonality that I spoke about. When we look at our customer base, we expanded both sequentially as well as year-over-year. We're very much, Travis, at the early innings of this. I'd say we're about 5% penetration and CGM is around 55%. We are actively preparing for a highly transformative launch, where we're gonna be sharing our feasibility data at the upcoming ADA, called EVOLVE. We've just enrolled our first patient last week. This will be what I call the industry's first truly fully closed-loop system for Type 2. Like, what do I mean by that? It's as CGM-like as you can get.

You put it on, no bolus, no user interaction, no settings, which unlocks the whole primary care physician audience, and really uber user consumer-friendly training. We specifically designed our fully closed loop to unlock that huge TAM in Type 2 where they need it to be a CGM-like experience.

What about the retention piece?

I would say, listen, we have healthy retentions. We're not seeing any meaningful change year-over-year. We're getting to know this market, and I would say we're innovating our customer experience model. From an aggregate basis, our total company, we still have about 90% retention.

Yeah. Travis, I would just say, I think, you know, you're alluding to my prepared remarks. I talked a bit about a slight deterioration in the U.S. as we continue to expand into Type 2. This was very much in line with our expectations. You know, it is a different population, and the retention or attrition is exactly what we expected it would happen. We are pleased also to see that internationally, the retention actually, as we launched, Omnipod in additional markets, has improved meaningfully. On a total company basis, as Ashley said, retention remains very stable.

Okay. What % of the new starts were Type 2 this quarter? I think I missed that. When you think about the seasonality comments, is there any impact on the seasonality from the Type 1, Type 2 mix or kind of the macro? Just kind of curious to follow up on the seasonality comments.

No, I think, listen, Travis, we had really healthy. I told you, total year-over-year growth. We experienced some softness in Q1 as a slower start for NCS. Customer of our base is strong. You know, I often get asked the question about, like, Type 2, and I told you, we've got really strong momentum. I often get asked about, like, the GLP-1s. Is that slowing down the progress in Type 2s? We did not observe an impact from increased GLP-1 use on Type 2 NCS this quarter. You know, I've always been sharing that we think that GLP-1s are very complementary to AID therapy, not competitive. It's in fact what we studied in our SECURE-T2D trial.

You know, we see diabetes as a chronic progressive disease and no data that nobody's been able to show that you can reverse beta cell decline. You know, once you get on insulin, AID is really the standard of care for the ADA. We look again at this huge TAM of 5.5 million people with Type 2 diabetes using insulin, and yet only 5% or less are using AID. We really look to unlock this right now and really drive accelerated penetration when we have our fully closed loop launching in 2028. Go ahead, Eric.

Travis, just to build on the numbers, the split of Type 1 and Type 2 NCS was about 40% Type 2 NCS in the quarter, with similar seasonality seen in Type 1 and Type 2, ever so slightly more in Type 2, but consistent across the two segments.

Our next question comes from Larry Biegelsen from Wells Fargo. Please go ahead, your line is open.

Good morning. Thanks for taking the question. I'll just keep it to one, Ashley, and I'm gonna try to ask the competition question a little bit differently maybe than it's been asked before. We understand, you know, you believe it'll be hard for competitors to manufacture a tubeless pump or ramp the manufacturing, but I don't think you're saying that there won't be any tubeless competition in the future. My question is, as your share of tubeless pumps declines from 100% today, I mean, it just mathematically has to go down if there's competition. What offsets that to maintain your 20% growth goal? Is it faster overall pump market growth, or is it a greater shift from tube to tubeless pumps or both? Thanks.

I mean, thanks, Larry, for the question. The short answer is this is not a market share trading. This is about bringing new people into the category and the category expanding as a whole. I mean, we're the market leaders, and we have a substantial distance versus the others, and I fully expect us to sustain share leadership. You know, I was talking about we have no intention of ceding our tech leadership. Next year, we're gonna be on our sixth generation Omnipod while others attempt to come out with their first. We know there's been a history of you know, the competition trying to work on tubeless solutions for decades, which really underscores how hard it is, how complex it is to bring these highly disposable devices to market. There's really a graveyard of a lot of failed attempts.

We have a head start of really mastering how to develop and manufacture at scale, and this has given us a remarkable cost advantage and scale advantage, and we've got the earnings power to keep growing. I think what's really important in this category is to understand that when new entrants enter, all boats rise. This increased promotion and the increased awareness will accelerate category expansion, which is exactly what we're seeing in the Type 2. When you look back from four years ago, we had about 60% of patients coming from MDI into the AID category, and that number is now 80%. The category is expanding.

Our next question comes from Matthew O'Brien from Piper Sandler. Please go ahead. Your line is open.

Great. Thanks so much for taking the questions. I'll ask them both up front. I hate to beat this dead horse on new customer starts in Q1, Ashley, but I'm going to. You've got a bunch of new competitors in the pharmacy channel. I just want to make sure there wasn't any kind of disruption maybe early in the quarter as they were pushing on the pharmacy side, so it made it more difficult for you to get patients through the pharmacy channel, and that's why you saw a little bit of softness. Then the second question is, there's a lot of investor consternation around the recall. Can you just frame up what you're seeing in the marketplace or from your customers in terms of the recall and the impact it's had on the business and then ability to add new patients? Thanks.

Yeah, no. Thank you, Matt. Let me first be very clear. In quarter one, we don't think price had an impact. In fact, U.S. pricing for us was positive in quarter one, and we expect this to continue for the full year. What we've been seeing as others have entered the pharmacy channel pricing and rebate behavior has been really rational and disciplined. So we are not seeing significant discounting relative to the norm. Our strategy is about creating durable, high quality access with broad affordability. So we are not going to trade long-term value for short-term positioning. I think what's really important to understand that maybe not fully appreciated is the significant size and scale that we benefit from. You know, our volumes are multiples larger than the nearest competitor, and we don't expect that dynamic to change now or in the foreseeable future.

You know, you put that coupled with we're the number one prescribed brand, and we are the number requested, and this is what gives us confidence for pricing going. Important, but we still lead with a competitive advantage there. Let me go to your second question, which is about quality and our recent medical device correction. I would say, hey, listen, in our industry, field actions are a part of being in a healthcare industry, but it was an absolute tough moment for us. Patient safety is always our number one priority. You know, we're monitoring and we're investigating customer complaints routinely. I am proud with how our team rapidly responded to the voluntary medical device in March. We do not believe that the medical device correction did have an impact on NCS in the quarter.

As I discussed, I believe the slower start was really due to the broader quarter one seasonality and the reset of the deductibles. Now, last week was another tough week with the FDA updating its communication about our MDC to reflect our April tenth update and misreported MDRs as SAEs. Listen, I know this created a bunch of confusion, and we're really not happy about that. What's important to know, though, is no additional adverse events from the MDC have been reported since the April tenth update. If anything, taking a step back, I think this really enunciates the high level of complexity of manufacturing sophisticated disposable electromechanical devices at scale. You know, in our industry, it's not possible to eliminate all risk, but what matters most is how issues are identified and addressed.

In this case, we got after it early, we've implemented targeted corrective actions, and we are going to continue to strengthen and invest in our quality systems and operating controls.

Our next question comes from Jeff Johnson from Baird. Please go ahead. Your line is open.

Thank you. Good afternoon or good morning, everyone. Ashley, I just wanted to follow up on that pricing comment. You said net pricing was up in the U.S. in 1Q. I just want to make sure that's net. That's not a WAC comment. That's actually a net of rebates up in 1Q. It sounds like you're expecting that to be true for the year as well. Just wondering, you know, we're hearing from a couple of our other companies that we speak with that they're expecting pharmacy pricing next year on a net basis to also be up again in 2027 over 2026. I know that's hard to predict at this point and you won't know until you know later this year.

As we're kind of trying to set up our models for the next year or two, would you still build in kind of flattish pharmacy pricing in the U.S. market over the next couple of years? Would that still be kind of how you'd guide us as we build our models over the next couple of years?

Yeah. I would say consistent with our Investor Day, Jeff, we expect pricing to be positive over the next three years. Quarter one is a data point, and we expect that to continue in full year 2026. Again, it speaks to just the strength of the clinical and then economic value proposition that AID as a category has for payers and for PBMs.

Okay. Again, just to confirm, that's net, not WAC you're talking?

It is net, Jeff.

Okay. Thank you. Just on Type 2, I just want to make sure I understand the retention and utilization comments you're making on the U.S. Utilization was stable, retention may be under a little bit of pressure. Is that to imply that if I'm a Type 2 patient going on Omnipod 5, I'm using it every day or pretty much normally like a Type 1, but just more of those Type 2 patients are trying it for three months or six months and then saying, "Nah, maybe it's not for me." Utilization when I'm an OP5 user is stable, but more of those Type 2s may be dropping out after three or six or nine months or whatever, not sticking with it. Is that the way to think about what you're trying to communicate today? Thanks.

No, thank, thanks for the question. I think what we're learning in the patient journey of being Type 2, again, we're sourcing the predominant amount from MDI, is a little bit of the ongoing support it takes them to get them on to Pod and the reinforcing support that we need to do really early on. Then it smooths out and really there's a learning agility that has to happen early on. Then what we're finding is really good brand loyalty and really good retention over time. It is a bit of a different class than what we said in Type 1, but overall, very encouraged with the progress that we've had about 18 months into this launch. Do you wanna add anything, Eric, to that?

No, I think exactly as you described, we're seeing, as you laid out, utilization for Type 2 stable, pretty similar to Type 1, and retention, the drop off, particularly early, getting folks accustomed to wearing the product, as Ashley described, is a little bit different. So we're learning and evolving our model of how we get folks successfully on so that they can stay enduring happy, successful customers on Omnipod.

Our next question comes from Jayson Bedford from Raymond James. Please go ahead. Your line is open.

Good morning, thanks for taking the question. Just on the 2Q international growth guide, it implies a bit more of a deceleration than I would have thought given what was obviously a very strong 1Q. Comps not too much different. I guess my question is, one, are there any stocking impact in 1Q that may be related to some of the new international countries? Two, just outside of the comp, what weighs on 2Q international growth? Thanks.

Jayson, I'll take that. In international, while, as I said, price mix realization will continue to be positive, the pace of it will moderate a little bit as we sort of anniversary some of these launches and, you know, continue the evolution of our install base from Dash to Omnipod 5. The dollars will continue to be sequentially increasing quarter over quarter on a constant currency basis. The growth rate, as you pointed out, will decelerate.

Our next question comes from Shagun Singh from RBC. Please go ahead. Your line is open.

Great. Thank you so much. I just had a quick follow-up. The $10 million in revenue that shifted into Q1, can you just, you know, elaborate on, you know, what the nature of that was? With respect to my question, Ashley, I was hoping you could talk a little bit more on the commercial front. You know, you guys are looking, you know, you guys are strengthening your message around the algorithm time and range. You've called out three algorithm launches in the next three years. You know, how meaningful are those upgrades? The U.S. sales force expansion, any way to think about the pace of that? You know, should we expect you to continue to do that throughout 2026? Thank you.

Thank you, Shagun. Let me kind of start with your first one. We had about 10 million just from some inventory that was coming in quarter one. It went actualized. It'll come out of quarter one. You'll see, I mean, quarter one, we have a really strong call. We had 29% growth last year, so we do have a stronger comp, but we see momentum continuing in the U.S. You know, I think it's important that I just spend a brief moment. You've heard me talk a lot about what are we doing commercially to strengthen our engine, and there's two things that I would share, Shagun, to your point. Number one is investing in our field.

It's our number one P&L item and making sure that we are upskilling our force to sell clinically in addition to their beautiful passion of selling our disruptive form factor. We've just retrained and retested all of our reps. We actually have the largest sales rep force in the category. And then we are expanding our call points with improved targeting and segmentation and improving our reach and frequency with an expanding prescriber base. To your point about clinically, you know, they've gotten really good momentum of selling our optimized setting, improving time and range. They're gonna be out there this quarter talking about our new lower set point at 100, as well as keeping people more in automated mode.

We're integrating with FreeStyle Libre 3 Plus, which brings with us 450,000 users from MDI that are on FreeStyle Libre 3 who are not on Omnipod into our portfolio. You can look at our website, Shagun, I would say, where we're listing all of our updated clinical evidence relative to what's available in the industry. Please take a look at that. Then obviously maintaining our competitive advantage in market access and affordability is a second lever. The third, you heard me talk about this in my remarks, is really about getting our clinical performance out there. We've doubled the amount of our professional events in the past quarter. In fact, we've significantly invested. In 2020, we were around 50 a year. We elevated that to about 100 to about 50.

A couple years ago, we executed 500 peer-to-peer education programs in 2025, really all about clinical performance. The last really is about this brand. It was really cool to see us kind of being dropped into culture on Scrubs. We got a lot of feedback of making the category really accessible to a lot more people. This is what we will continue to do to grow the category. Thanks for the question, Shagun.

We have time for one last question. Our last question will come from Matt Taylor from Jefferies. Please go ahead. Your line is open.

Hi. Good morning. Thanks for taking the question. I wanted to ask one on the tailwinds that you called out in 2027, specifically on Omnipod 6. Do you expect that launch, I guess, to drive just increased share gains and customer starts? Could you actually get price mix benefits from the launch of Omnipod 6 as well?

You know, I mean, listen, this is going to be our 6th generation. It's really to shore up to continue to extend our leadership and deliver our role of continuing to build a category and bring people in from MDI. It will have our, Matt, our third algorithm improvement. Again, I come back to the simplicity, if you're on MDI, how to keep it really simple. This new algorithm is going to have greater automation, it's going to have less bolusing, it's going to have a reduced user interaction. It was designed exactly to bring more people into the category. We're going to have some of our data shared at the ADA coming up in June of our STRIVE, which will show about our clinical performance.

You know, the fun thing maybe underappreciated as I would share is sensors have gotten really small, and our Omnipod 6 also has dramatic improvement in what we call over-the-air improvements so that people can wear it on multiple places of their body. We get a lot of feedback on that. Importantly, we're also moving to a single pod chassis, which allows prescribers to only write one script versus two scripts regardless of your sensor, and it clearly has a big impact on our supply chain and simplification. Thank you for the question, Matt.

Thank you.

Listen, let me just thank everybody for your questions and engagement. We are very encouraged by the momentum of the business that we're seeing. We look forward to updating you on our continued progress. Thanks so much.

Ladies and gentlemen, this concludes today's conference. Thank you for your participation, and have a wonderful day. You may all disconnect.

Good morning, and welcome to the Insulet Corporation Fourth Quarter and Full Year 2025 Earnings Call. As a reminder, this conference call is being recorded. I would now like to turn the conference over to your host, Clare Trachtman, Vice President, Investor Relations.

Good morning, and welcome to our Fourth Quarter and Full Year 2025 Earnings Call. Joining me today are Ashley McEvoy, President and Chief Executive Officer; Flavia Pease, Chief Financial Officer; and Eric Benjamin, Chief Operating Officer. On the call this morning, we will be discussing Insulet's fourth quarter and full year results, along with our financial outlook for the first quarter and full year 2026. With that, let me start our prepared remarks by reminding everyone that certain statements, including comments regarding our financial outlook for the first quarter and full year 2026 the anticipated impact of our strategic actions, the potential impact of various regulatory and operational matters and the macroeconomic environment on our results of operations contain forward-looking statements that involve risks and uncertainties. And of course, our actual results could differ materially from our current expectations. Please refer to today's press release and our SEC filings for more detail concerning factors that could cause actual results to differ materially. In addition, on today's call, non-GAAP financial measures will be used to help investors understand Insulet's ongoing business performance, including adjusted operating income, adjusted EPS, adjusted EBITDA, adjusted tax rate and constant currency revenue, which is revenue growth, excluding the effect of foreign exchange. A reconciliation of certain non-GAAP financial measures being discussed today to the comparable GAAP financial measures is included in the accompanying investor presentation and available in our earnings release issued this morning, which are both available on our website. Additionally, unless otherwise stated, all financial commentary regarding dollar and percentage changes will be on a year-over-year reported basis with the exception of revenue growth rates, which will be on a year-over-year constant currency basis. During the Q&A session this morning, Ashley, Flavia, Eric and myself will be available to address any questions. Now I'd like to turn the call over to Ashley. Ashley?

Thank you, and good morning, everyone. I'm pleased to share that we closed 2025 with another strong quarter, recording our 10th consecutive year of 20% or greater constant currency revenue growth. This consistent track record reflects the strength of our durable recurring revenue, profitable business model and the breadth and depth of our competitive moats. Our strong clinical evidence and real-world outcomes continue to earn prescriber and patient confidence and the consistency of our execution, along with the deep commitment of the Insulet team to finding a better way for people living with diabetes has enabled us to deliver enhanced value to all of our stakeholders. I want to start by thanking our Insulet employees around the world. 2025 was a year of significant progress at Insulet and the entire organization delivered on our goals without missing a beat. Your dedication to our mission fills me with confidence today and well into our future. Our results in the fourth quarter are a testament to the reliability, consistency and broad appeal of Omnipod, coupled with the strength of our strategy and execution. Total company revenues were $784 million, advancing 29% constant currency. U.S. revenues of $568 million increased 28% and international revenues of $214 million grew 42% constant currency. This strong finish to the year enabled us to surpass $2.7 billion in revenue for the full year, more than doubling our revenue base over the last 3 years and delivering approximately 30% year-over-year constant currency growth. Our annual performance of $1.9 billion or 27% growth in the U.S. and $754 million or 39% constant currency growth in international markets highlights the progress and the impact we're making as we continue to unlock more of our $30 billion-plus total addressable market. We achieved record new customer starts across both the U.S. and international in the fourth quarter and for the full year, with the vast majority coming from people transitioning from multiple daily injections. This reflects growing provider confidence, which, as I just mentioned, is driven by strong clinical evidence and consistent real-world outcomes. Importantly, it also reinforces that Insulet is not only the market leader in AID, but also the clear driver of overall market expansion, and we intend to maintain this leadership position. Turning to our key markets and starting with our largest, U.S. type 1, where we continue to focus on extending our leadership. The U.S. type 1 market is a more than $9 billion opportunity with AID penetration at just 40%, which is well behind CGM penetration of 70%. In 2025, we delivered year-over-year growth in type 1 new customer starts in both the fourth quarter and the full year, driven by strong patient and prescriber preference for Omnipod. In fact, both type 1 and type 2 users in the U.S. named Omnipod 5 their favorite pump in 2025. Omnipod's strong clinical evidence, broad access, affordability and ease of use are enabling us to expand well beyond traditional endocrinology channels. Our U.S. prescriber base now includes more than 30,000 health care professionals, up approximately 28% year-over-year. The strength and reach of our commercial teams position this segment to remain a meaningful and consistent contributor to our global customer growth. Momentum in the U.S. type 2 continues to build as well. In the fourth quarter, type 2 new customer starts grew significantly, both sequentially and year-over-year, rapidly expanding our type 2 user base. This acceleration reflects strong clinical and real-world outcomes, continued investment in demand generation and the recent ADA guideline update recommending AID for people with type 2 who require insulin. Our type 2 prescriber base grew 62% in 2025 to now more than 6,500 clinicians. Most people with type 2 diabetes are being managed in primary care settings. Therefore, expanding beyond endocrinology represents a meaningful and sustainable growth opportunity. In a type 2 market of more than $12 billion, where AID penetration remains below 5%, which is far behind roughly 55% of CGM adoption, stronger education, improved outcomes and increasing access are already accelerating adoption. Importantly, we are unlocking this opportunity in a strategic and capital-efficient way. Our U.S. sales force, which is the largest in the industry, reaches high-prescribing offices that treat both type 1 and type 2 diabetes, giving us confidence in our ability to unlock the next 5% to 10% of type 2 penetration efficiently. Our growing type 2 customer base continues to surface powerful stories about the impact Omnipod 5 can have including the experience of Verquise. He knew something was wrong when he began experiencing pain in his feet and arms and an urgent care visit led him to an unexpected diagnosis of type 2 diabetes. After reviewing insulin delivery options with this doctor, Verquise chose Omnipod because he shared, I really love the mission and the promise that was exuded from Omnipod to add normalcy to my diabetes and to show that my life can still be balanced and that this brand, this family will always be there and will forever evolve as medical technology does. Stories like Verquise, combined with the growing excitement among both health care professionals and people with type 2 diabetes, continue to strengthen our conviction in this significant type 2 market opportunity. Looking ahead, we expect to expand penetration even further with the launch of our fully closed-loop offering planned in 2028, which will enable us to reach and serve the broader primary care population. Additionally, pharmacy access remains a critical differentiator in the U.S., making it easier for people with diabetes to start and stay on therapy. Over the past decade, we've built strong relationships with payers and PBMs across the U.S., backed by clinical and economic evidence that continues to resonate. We have the broadest access in the market available in approximately 48,000 U.S. pharmacies and covered for more than 90% of insured lives or about 300 million of the 317 million insured people. Our offering is affordable with most users paying about $1 a day through our pay-as-you-go model and preferred formulary position. And we continue to invest in programs designed to further reduce the remaining barriers to access, including efforts to simplify the prior authorization process for providers, particularly among primary care prescribers who treat large numbers of people with type 2 diabetes. Omnipod also continued to drive standout international performance, fueled by strong year-over-year and sequential growth in new customer starts, along with continued positive price/mix realization driven by conversion from Omnipod DASH to Omnipod 5. We continue to see solid performance across our established European markets, supported by new sensor integrations such as our launch with Dexcom G7 in Germany. Our Omnipod 5 launches in Canada and Australia also delivered robust growth. In Canada, we secured reimbursement, recognizing Omnipod 5's value in half of all provinces, helping drive more than 60% growth in new customer starts. And in Australia, new customer starts more than tripled following the launch of Omnipod 5. Our global expansion will continue in 2026 with Omnipod 5 and Omnipod Discover recently launching in the Middle East. In addition, Spain, our newest market, is expected to launch Omnipod 5 later this year. Volume remains the primary driver of our international growth and the ongoing transition from Omnipod DASH to Omnipod 5 will continue to support positive price/mix realization. Pricing contributed high single-digit growth in both the fourth quarter and the full year 2025. Our international growth runway remains substantial. The type 1 market alone exceeds $10 billion, yet only 1 in 4 people with diabetes outside the U.S. is using AID therapy, even as CGM penetration reaches around 65%. As adoption of AID accelerates worldwide, our proven commercial playbook, expanding product portfolio and growing geographic footprint position us extremely well to continue capturing share, delivering value and driving sustained international growth. To bring this all together, we have a large underpenetrated TAM across U.S. type 1, U.S. type 2 and international markets with significant runway to unlock additional growth in one of the fastest-growing categories in MedTech. And our proven track record reinforced by our performance this year underscores our ability to continue to deliver top-tier growth and value creation for shareholders. Notably, this top-tier growth has allowed us to deliver meaningful margin expansion even as we continue to invest thoughtfully to extend our competitive advantages in innovation, clinical outcomes, access, brand and manufacturing. For the year, we achieved record gross and operating margins, delivering 180 basis points of gross margin expansion and 270 basis points of operating margin expansion. We remain committed to investing with discipline, ensuring we sustain the strong growth we are delivering today while also driving continued improvements in profitability. The investments funded by our durable recurring revenue, profitable business model and strong financial position fueled significant progress across every aspect of our strategy in 2025. We expanded our global scale this year with launches in 9 new countries, launched our G7 CGM integration, increased full phone control adoption to more than 60% of U.S. users and continued building the foundation for our next-generation systems. We also advanced our clinical programs in meaningful ways. We published results from SECURE-T2D and RADIANT, completed the STRIVE study for Omnipod 6 and moved into the next phase of our EVOLUTION study supporting our fully closed-loop system for adults with type 2 diabetes. Collectively, these programs further strengthen the scientific foundation behind Omnipod, advancing our algorithms for optimal performance, fortifying the case for broader AID adoption and enabling continued global expansion. We invested in market development in new, more visible and impactful ways. Our expanded sales force is now more than 25% larger than our nearest competitor. Our DTC campaigns are generating record lead volume and activating new prescribers. And our enhanced insights and analytics capability are helping us optimize our cost to acquire and cost to serve, driving continued expansion in customer lifetime value. These advances and efforts have solidified Omnipod's status as the most requested, most preferred and most prescribed AID system. Among new customers, 70% of those who walk into a prescriber's office request a brand ask for Omnipod 5. And among existing users, Omnipod 5 maintains the highest Net Promoter Score in the category. Now I want to take a few minutes to walk through how we will continue advancing the long-term strategy we outlined at our 2025 Investor Day to extend our leadership and strengthen patient and physician choice for Omnipod. Innovation remains central to our strategic approach. And in 2026, we will deliver a steady cadence of highly requested enhancements to reinforce our leadership in automated insulin delivery. This includes algorithm updates that enable a 100 set point target for tighter glycemic control, increased time in automated mode and improve responsiveness to enhance both the user experience and clinical outcomes. We will also expand our CGM integrations to include FreeStyle Libre 3 Plus, making Omnipod 5 compatible with every major sensor, and we will roll out Omnipod Discover globally. Omnipod Discover is a new data platform that delivers clear streamlined insights to support efficient health care professional review of Omnipod 5 data and enable more confident prescribing. Discover provides users with actionable guidance and reassurance, strengthening engagement and adherence. It also simplifies onboarding, reducing efforts for new users and accelerating the start-up experience. Collectively, these enhancements reduce day-to-day effort with fewer device interactions, broader CGM choice and more actionable insights that help patients and clinicians with confidence. In 2026, we will continue to purposely increase R&D investment to advance our next-generation platforms, including Omnipod 6 as well as our fully closed-loop system for type 2 diabetes and future innovations. This also includes continued progress across our clinical programs with ongoing work in STRIVE and EVOLUTION. Let me take a moment to share more on our next-generation platform, starting with Omnipod 6. This system is designed to address the critical needs of users by meaningfully reducing day-to-day burden and increasing flexibility through improved connectivity, expanded flexibility in on-body placement, real-time software updates and more personalized automation. It will feature a smarter algorithm to further personalize insulin delivery with pivotal data to be presented at ADA in June. Importantly, we are designing a single updatable Pod platforms that will be compatible across all CGM systems. These capabilities not only improve outcomes and the wear experience, but also accelerate our innovation cycle as we prepare for launch in 2027. Turning next to our fully closed-loop system for people with type 2 diabetes, which is designed to make AID accessible to virtually everyone. As the market leader in AID, it's important that we define what fully closed loop truly means for patients and providers. It is a system that delivers therapy effortlessly, adapting automatically without any user intervention. No dosing, no mealtime actions and no required adjustments while the Pod is worn. For us, fully closed loop also means redefining the provider experience, requiring no clinician-defined settings to start and simple enough for a patient to initiate on their own. Reflecting this definition, we believe our fully closed-loop system will help address a significant unmet need for the 5.5 million people with type 2 diabetes who are on insulin, only about 25% of whom achieve recommended glucose targets today. We expect to initiate our pivotal EVOLUTION study this year, supporting a regulatory filing in 2027 and a commercial launch in 2028. Finally, operational excellence remains a core focus as we work to expand margins in 2026, while continuing to fund our R&D and commercial investments. In 2025, we delivered significant margin expansion driven by scale and ongoing manufacturing productivity with our Acton and Malaysia facilities ramping ahead of plan. In 2026, we expect additional leverage as we invest in more capacity and further automation. And with the help of AI, we are increasingly tapping into our unique cloud-based data ecosystem to enhance customer service efficiency and satisfaction, reducing our cost to serve while strengthening retention. Taken together, these priorities position us extremely well to execute on our long-term strategy and continue strengthening and driving choice for Omnipod among patients and providers worldwide. All of these investments, strategies and consistent execution come together in the financial growth algorithm we introduced at our 2025 Investor Day. Our 2026 guidance aligns fully with this growth outlook, and Flavia will walk through the details in a moment. This outlook is supported by our continued investment in innovation, science, market development, demand generation and manufacturing, balanced with the discipline that has defined our execution over the past several years. We remain committed to delivering market-leading financial performance while investing in the next wave of transformative innovation. We entered 2026 with strong momentum and clear priorities that position us well and give us confidence in achieving our financial goals. To close, 2025 was a year of tremendous growth for Insulet, financial, strategic and organizational. We expect to build upon this in 2026 as we lighten the burden of living with diabetes for hundreds of thousands of people and in doing so, drive penetration, increase our scale and create value for our shareholders. We operate from a position of strength with durable competitive advantages, a large and underpenetrated market and a purpose-driven, highly motivated team committed to finding a better way. We look forward to extending our leadership in the year ahead and beyond. Thank you for your continued support and interest in Insulet. I'll now turn the call over to Flavia to walk through the financials and guidance in more detail.

Thank you, Ashley, and good morning, everyone. The Insulet team had another strong year in 2025 and closed with an impressive fourth quarter, delivering over $780 million in total revenue, an increase of 31.2% at reported rates and 29% at constant currency rates. During the quarter, total Omnipod grew 31.3% on a constant currency basis. We generated total revenue of over $2.7 billion in 2025, an increase of 30.7% at reported rates and 29.5% at constant currency rates. For the year, total Omnipod grew 30.3% on a constant currency basis, showcasing sustained global demand for Omnipod 5. Across both fourth quarter and full year, we achieved record new customer starts in the U.S., international markets and company-wide, with growth accelerating on both a year-over-year and sequential basis. In the U.S., during the fourth quarter, over 85% of new customer starts came from MDI and type 2 represented over 40% of all starts, underscoring the significant expansion of this customer segment. Our estimated global utilization and annualized retention rate remained roughly stable for the fourth quarter and the full year. Now turning to our performance in greater detail. U.S. Omnipod revenue grew 28% in the fourth quarter and 27.2% for the year, above the high end of our guidance range, driven by continued demand for Omnipod 5 across type 1 and type 2 customers. As we commented last quarter, U.S. revenue growth during 2025 was impacted by rebate timing and prior year inventory stocking dynamics. Normalizing for these impacts, U.S. growth in the fourth quarter was approximately 30 basis points higher, representing an acceleration from normalized third quarter growth levels. Our international Omnipod business grew 50.7% on a reported basis and 41.7% on a constant currency basis for the fourth quarter. For the full year, international Omnipod revenue grew 44.1% on a reported basis and 39.3% on a constant currency basis. Volume was the primary driver of international Omnipod growth, while positive price/mix realization continued to contribute as customers shift from Omnipod DASH to Omnipod 5. As in prior quarters, we witnessed strong growth in the U.K., Germany and France, in addition to the other countries where we have launched Omnipod 5. In 2025, our 9 expansion markets collectively delivered growth in line with the U.K. and Germany combined, reflecting the broad market appeal of Omnipod 5 and benefits to patients globally. Continuing down the P&L, our fourth quarter gross margin was 72.5%, reflecting a 40 basis point expansion year-over-year. Our full year 2025 gross margin of 71.6% reflected a 180 basis point expansion year-over-year. This improvement was fueled by robust top line growth, continued manufacturing productivity gains at our Acton and Malaysia facilities, supported by positive pricing and increased volumes. As mentioned last quarter, Malaysia became margin accretive just 1 year after coming online. Turning to OpEx. We continue to make purposeful investments to both maintain and extend our leadership. We are fortunate to be in a position where we can meaningfully fund our innovation pipeline and ensure we are first to deliver truly transformational technology to the market. In line with this commitment, we increased R&D spending by 50% in the fourth quarter and 37% for the full year as we advanced our innovation road map and clinical development programs, including our STRIVE and EVOLUTION studies. At the same time, we remain disciplined and targeted in our SG&A investments. We continue to prioritize market development initiatives to unlock AID penetration and demand generation efforts, including expanding our commercial and customer experience teams to drive share and increase retention of our leading AID technology across both type 1 and type 2 diabetes. For the year, we successfully optimized both our cost to acquire and our cost to serve, 2 key metrics we remain focused on improving as we enhance customer lifetime value. Fourth quarter adjusted operating margin of 18.7% reflected robust revenue growth, strong gross margins and continued investment to advance innovation and key commercial strategies. Our full year adjusted operating margin was 17.6%, ahead of our most recent guidance and representing 270 basis points of expansion versus the prior year. As Ashley mentioned, we are well positioned to continue investing robustly for future growth while delivering meaningful margin expansion for years to come. Fourth quarter net interest expense was $9.2 million, an increase of $11 million relative to prior year, primarily driven by the debt refinancing. Full year net interest expense was $24.7 million, an increase of $22 million compared to the prior year, again, primarily driven by impact of our senior unsecured notes issued in March. Our fourth quarter non-GAAP adjusted tax rate was 22%, and our full year non-GAAP adjusted tax rate was 22.3%. Fourth quarter adjusted EPS was $1.55, increasing 35% from $1.15 in the prior year comparable period, while full year 2025 adjusted EPS was $4.97, up 53% from $3.24 in the prior year. During the year, we repurchased approximately 184,000 shares for $59.6 million. Turning to cash and liquidity. We ended the quarter with $716 million in cash and the full $500 million available under our credit facility. We delivered more than $375 million in free cash flow for 2025, a 24% increase over last year. 2025 free cash flow included approximately a $70 million tax benefit related to the One Big Beautiful Bill. As a reminder, free cash flow includes capital expenditures, which grew meaningfully in the fourth quarter to $135 million, reflecting our continued investment in manufacturing capacity. This included further expansion of our Malaysia operations with additional lines coming online as well as the start of development of our new facility in Costa Rica, which is expected to be operational in 2029. These investments strengthen our global footprint, advanced our automation initiatives and position us to support industry-leading growth while continuing to expand margins over time. Now turning to our outlook for the first quarter and full year 2026. For the first quarter, we expect Omnipod revenue to grow 28% to 30% with total company growth of 25% to 27%. On a reported basis, foreign currency is expected to provide a favorable impact of about 200 basis points to both measures. In the U.S., we anticipate Omnipod growth of 24% to 26%. And in our international business, we expect Omnipod growth of 37% to 39%. On a reported basis, foreign currency is expected to contribute a favorable impact of roughly 1,100 basis points to international growth. Turning to our full year 2026 outlook. We expect our total Omnipod revenue to grow 21% to 23% and our total company revenue to grow 20% to 22%. We expect a favorable impact of 100 basis points from foreign currency for the year. Our guidance reflects continued top-tier market-leading growth, but I know you will all ask me why is growth decelerating? Just a couple of quick notes on this. First, this year, we will be anniversarying the first full year of the U.S. launch of Omnipod for type 2, which was a significant contributor to last year's performance. In addition, we're beginning to annualize several of our international launches, which continue to ramp well, but create more challenging year-over-year comparisons. These year-over-year comp dynamics are reflected in our 2026 guidance. For U.S. Omnipod, we expect our revenue to grow 20% to 22%, driven by increased penetration from MDI users and competitive gains. We expect year-over-year growth in U.S. new customer starts for the year, and we assume similar trends in pricing, utilization and retention as we saw in 2025. For international Omnipod, we expect 2026 revenue to grow 24% to 26%. On a reported basis, we expect a favorable impact of approximately 300 basis points from foreign currency. We expect year-over-year growth in international new customer starts for the year as we penetrate further in current markets and expand Omnipod 5 into new markets. Omnipod 5 is now available in 19 countries, including 5 recent additions in the Middle East, and we will continue to broaden our reach and plan to enter Spain by late 2026. While volume remains the primary driver of our international revenue growth, our guidance also reflects a benefit from positive price/mix realization as customers continue to transition from Omnipod DASH to Omnipod 5. Overall, our international growth guidance assumes stable utilization and slightly improving retention from 2026 relative to 2025. Turning to 2026 operating margin. In line with the annual guidance we provided at our recent Investor Day, we expect to drive approximately 100 basis points of operating margin expansion for the full year, reflecting strong top line growth, modest gross margin expansion, a significant step-up in R&D investments to fuel our innovation pipeline and leverage SG&A spend. Looking at a few items below our operating income. We expect 2026 net interest expense to total approximately $40 million, primarily due to lower interest income, and we expect 2026 non-GAAP tax rate to be in the range of 22% to 23%. Our team is actively focused on assessing potential opportunities to optimize our interest expense and tax rate over time. Turning to shares outstanding and EPS. I'm pleased to share that the Board has approved an additional $350 million share repurchase authorization. We expect to deploy approximately $300 million of this authorization into the first quarter of 2026. Our strong balance sheet gives us the flexibility to continue allocating capital in line with our long-standing principles, investing for growth while delivering long-term value for our shareholders. Based on our current share count and repurchase plans, we expect the 2026 ending balance of our diluted share count to be around 70 million shares. Based on these factors, we expect 2026 adjusted EPS to increase by more than 25%. We expect free cash flow to be approximately flat from 2025 levels, supported by robust growth and continued margin expansion, partially offset by a ramp-up in capital expenditures to support our continued global manufacturing expansion plans. As I just mentioned, 2025 free cash flow included approximately $70 million related to a tax benefit from the One Big Beautiful Bill. Our team remains steadfast in its commitment to driving top-tier growth, expanding margins and increasing profitability and free cash flow. These efforts are central to our long-term value creation strategy and enable us to reach and serve more people with diabetes around the world. With that, operator, please open the line for questions.

[Operator Instructions] Your first question today comes from the line of Jeff Johnson from Baird.

Congratulations on a strong close to the year. Ashley, I just want to start from a high level maybe with the first question here. You're a couple of months away from your 1-year anniversary leading Insulet. Stock has had a great run in the first 6 months of your tenure. It's faced maybe some challenges here in the last 5 or 6 months. What do you think is the most underappreciated part of the Insulin story at this point, especially from an investor perspective?

Yes. Jeff, thanks for the question, and it's great to see Insulet continue to execute and live into our commitments that we shared in November at our Investor Day. I would highlight 4 key areas. Number one is our tech lead, which we'll continue to innovate off of. I'll come back to that. I would say number two is our growing commercial prowess. I'll come back to that. Three is our manufacturing at scale; and four is our financial strength. So I'll start with just our tech lead. As we shared, we've invested over $3 billion to get here. Omnipod 5, we're just 3.5 years into the launch, into the U.S., 2.5 years in places like the U.K. and Germany, and we continue to post record NCS. This knowledge, this experience and this tech lead really continue to prove the leadership that's resulted in, number one, most prescribed and number one most requested. And importantly, in my opening remarks, I really shared how we've built this meaningful pipeline that really addresses the biggest unmet needs in the market. And you heard us touch around really 2 algorithm improvements starting this actually weekend, we launched a limited market release with Omnipod 5 with a lower set point, advanced automated mode. It connects with Libre 3. We're going to be launching our new data platform. So that will be going out into full market release in a couple of months. We will be launching our third-generation algorithm with Omnipod 6. As we mentioned in our opening remarks, we're going to be posting the data and the algorithm at the ADA. This is a meaningful advancement in personal automation as well as over-the-air connectivity as well as on the bod placement with a lot of variability, which is important for patients as well as the 1 pod. And you're going to hear us talk about -- there's been a lot of noise, if you will, in the industry, which is really good things for patients around this fully closed loop. We believe that we are in a class by ourselves of how we're going to define what fully closed loop really means. I'll come back to that in inquiry. But it's a very strong pipeline. And then our commercial prowess, I think, is really underappreciated. We have the largest sales force in the industry. We are going to evolve that sales force for messaging from selling on simplicity and ease of use and our highly differentiated technology to our strength of clinical performance. I'll come back to that. And then as Flavia was mentioning in her opening remarks, 30,000 prescribers with Omnipod, which is up 28%. Very strong brand loyalty, and we continue to have unparalleled access and affordability. We manufacture at scale. It's one thing to get regulatory approval, it's different than to manufacture. We produce tens of millions of Pods with high-quality medical-grade quality at consumer electronic scale. And when we say something, we execute on what we're going to say. I'm really pleased the team is building out Malaysia. We're already margin accretive in Malaysia. In Acton, we've improved productivity, and we've already started to break ground on Costa Rica. And last is just the financial wherewithal and, you know, not only our recurring revenue model, 70% gross margin, expanding operating margin, EPS above revenue and cash flow positive. So those are perhaps underappreciated tenets of the Insulet company. Thanks for the question, Jeff.

Your next question comes from the line of Robbie Marcus from JPMorgan.

Congrats on a good quarter. I wanted to ask -- I guess it's limited to 1. I wanted to ask on new patient start trends, U.S. and outside the U.S. And we've seen some of your competitors stumble a bit on new patient adds recently. How are you thinking -- you mentioned record new patient starts, I believe that's a U.S. and outside the U.S., but you could clarify that if I'm wrong. How are you thinking about finding sources of sustainability in the new patient growth? Type 2 is clearly a home run for you in the U.S. How do you keep that growing and getting larger and larger and continuing to win there? And then same question outside the U.S., you've been moving into new geographies. How do you sustain your #1 share there and continue to grow that over time?

Thank you, Robbie. Yes, we did -- as I mentioned before, I think in Investor Day, we enjoy very balanced growth from the U.S. and OUS. We did enjoy record new customer starts in the U.S. as well as OUS. And our role as a category leader, as we shared, we've generated about 65% of the market growth has come from Insulet. And that really is the primary source of our volume are coming from people not in the category, and those are people on multiple daily injections. And so we engineer our innovations to address -- to bring new customers into the market. We do enjoy about 10% of ours comes from switching, and we are switching from competitive AID, but our primary source is coming from MDI. And that we can go into type 1, where we continue to improve new customer starts and post new records in type 1, both in the U.S. as well as OUS. In the U.S., that's backed by strong ADA guidelines. We mentioned that 40% of people on AID therapy, there's still a lot of room when CGM has 70% penetration. There's a 30-point spread. So backed by science, making the education to really educate on our very strong clinical performance as well as just kind of the unparalleled access and affordability in type 1. Type 2, Robbie, you mentioned we're at the nascent stages, 5% penetration. We have a very strong value proposition. We have very strong science. You're going to hear us talk more about kind of our strategic pivot, taking advantage of the largest channel of the #1 sales force in the U.S. of migrating from really sharing our differentiated technology into proven clinical outcomes. It's something, quite frankly, we own. There's a bit of a misperception in the marketplace that we have to correct and stand and set the record straight, which is in addition to our, if you will, preferred form factor and preferred user experience, we have very robust clinical performance on A1c reduction and improved time and range, not just in our clinical trials, but importantly, in 2 independent studies just recently that compared AID systems, Omnipod's A1c was unsurpassed and our time and range was similar. So we're going to take that message and that science to the largest channel of our P&L, which is our field force. Thanks for the question, Robbie.

Your next question comes from the line of David Roman from Goldman Sachs.

Maybe just sort of follow up on Robbie's question here. Can you help us reconcile script trends to what you're seeing in reported revenue? I think this is a dynamic that caused quite a lot of noise intra-quarter. So can you maybe size up how new patient start trends and volume growth compares to revenue? And if script data is not the right barometer, what should investors be using to track performance? And I have one financial follow-up.

Sure. Let me just turn to Flavia. Go ahead, Flavia.

David, thank you for the question. Yes, we know there had been a lot of questions around script data during the fourth quarter. So I think as a reminder, and we talked a little bit about this in -- at the JPMorgan conference in January. The best -- if you were going to use script data, the best would be to use total Pods as that's the best reflection of the future revenue outlook. If not -- if the total Pod data is not available, you can use total scripts. It will not capture potential changes to longer script fills, going from a 30-day to a 60-day to a 90-day, but it's also a good second best option. And then finally, you can use NBRx, but there is a little bit of noise on NBRx because of samples and also different channels. Specialty channel was not captured there as you use IQVIA data. And then finally, in the fourth quarter, there's a little bit of, I would say, seasonality where you see higher volume going through wholesale with specialty pharma than in other quarters, which is not necessarily captured in script data, but affects revenue. So there are a few items that folks have to take into consideration when they extrapolate from scripts into dollars of revenue.

Okay. And then are you willing to provide the difference between new patient start growth and overall revenue performance?

No. We'll continue to provide, I would say, qualitative commentary on our -- the strength of our new customer starts, and we talk about them. Ashley just mentioned the strong performance in both U.S. and OUS and the continued growth that we see as we continue to expand penetration of AID, but we're not going to provide specificity on new customer start growth rates.

Your next question comes from the line of Larry Biegelsen from Wells Fargo.

Congrats on the strong finish here. Yes, I'm going to ask, I think Jeff's question maybe a little bit differently. So Ashley, you're guiding to 21% to 23% Omnipod growth for 2026, and you gave a 3-year LRP of 20% recently. So my question is, how are you feeling about being able to sustain the 20% growth in light of new competition? And anything new you can offer on why you think investor concerns around competition are overblown? Do you think it's going to be harder for new companies to scale or compete directly with Insulet in the patch pump market? Or do you think their entries will have a rising tide effect?

Thank you, Larry, for the question. And again, I'm really pleased to see the confidence in the company even increased since our Investor Day that we shared in November. As we come as a company out of stealth mode to the position of market leadership, performance trumps everything. And again, I'll go back to some elements that I think are maybe underappreciated. Getting regulatory approval is not really the definition of impact. And we have this 25-year head start with, again, $3 billion of investment that's enabled us a lot of knowledge, a lot of tech know-how, a lot of experience on scale. And I think in this marketplace, if you look at history, there's been a lot of attempts because it is an attractive market. But I will tell you, there are a lot of barriers to entry. And those really come down to manufacturing at scale with high quality, it has to go to continuing to innovate with clinical performance and really unlocking the TAM. What's going to enable us to deliver the top-tier performance is by continuing to bring new users into this category. And our pipeline is specifically designed to bring new users from MDI into the category. And I think the biggest unmet need for us is to really start to improve the acumen among the clinical base, particularly in the U.S. of our strong clinical performance. So in addition to being #1 prescribed and #1 most requested predominantly because of our differentiated form factor and user experience, we also want them to know and be well aware of just the strong proven clinical performance, both efficacy and safety and unsurpassed in the category. I think that will be new information for many more clinicians. And then I'm going to come back to just continuing to build on our commercial prowess as we go, Larry. Again, I think this company has been known as being really good at technology and really good at the supply chain. What's perhaps underappreciated is this evolving commercial of having the largest sales force, selling on science, very strong. We're bringing new prescribers into the category. We have this beloved brand that we are activating. When we activate DTC, we generate record new leads into the category. We're converting those leads into brand loyalty. They become new Omnipod Podders. And then we continue to have unparalleled access and affordability. We've been at this pharmacy for 9 years, and we've built remarkable relationships with the payers and the PBMs because we have very strong clinical and economic evidence. And we're going to take that strength and continue because 100% of our portfolio is in pharmacy. So while others may be at the 10% or 30%, Omnipod has been at this for 9 years, and we'll continue to have unparalleled access and affordability. So thank you for the question, Larry. Flavia, go ahead.

Maybe -- just one final add is also the financial strength that we have. We have best-in-class gross margin, which has built through these investments that Ashley talked about over the years. We are free cash flow positive. And that strength allow us to continue investing in the business while at the same time being able to expand margins. And that investment is in innovation. It is in unlocking the market with AID penetration and it's also in capacity to invest ahead of demand when you are in a disposable form factor construct.

Yes, Eric sitting here, as we shared, Larry, we've got $1 billion that we're going to invest in R&D in just the next 3 years. And we also are planning new next-generation platforms beyond the 3-year window to stay ahead.

Your next question comes from the line of Michael Polark from Wolfe Research.

I have a question on one of your sensor partners. So G7 is moving to 15-day from 10-day. Is this a different Pod for Insulet? Or is this the same Pod? And if it's a different Pod, can you comment on the company's readiness to provide integration with the 15-day sensor? I'm just -- I'm remembering back to 2024, it took some time for the G7 Pod to become widely available and it kind of, I think, suppressed starts for a period of time before it was widely available. And so I'd like to understand the dynamics around the move from Dexcom to 15-day.

Thank you, Mike. And here's Eric, why don't you talk about our sensor integration?

Mike, thanks for the question. As a reminder, we were actually ready with the 15-day launch day 1 with Dexcom. So Omnipod 5 is compatible with the 15-day G7 now, and that's a great experience for customers. And one of the key things we've been focused on, as you know, Mike, is accelerating sensor integration for customers. We were ready day 1 with 15-day. As Ashley mentioned earlier, we began the limited market release of our Freestyle Libre Plus integration just recently, and we're excited to bring that to market in the first half of 2026. And then looking ahead to Omnipod 6, recognizing this need to evolve even faster with the market, it's part of why we're designing one Pod that can be updated in market for faster innovation so that with Omnipod 6, we can always push the latest technologies directly to Pods that customers have. So we're accelerating innovation and sensor integrations now. Pleased to be on market with Dexcom 15-day and assuring that we're positioned to do that going forward.

Your next question comes from the line of Travis Steed from Bank of America.

You talked about changing your guidance philosophy. So I just wanted to make sure we had understanding of how you kind of set this year's guidance versus prior years and kind of what's been baked in into 2026 versus what's left for upside? And also, do you expect record new starts in Q1 as well?

Thanks, Travis. Flavia, over to you.

Yes. Travis, we continue to set guidance with a full intent to deliver. That has not changed. The guidance that we provided today reflects a balanced view of our outlook at this point. And we will experience normal seasonality in the first quarter, which has been the case historically between fourth quarter and first quarter. But outside of that, we are very confident and pleased to be able to provide an outlook of 25% to 27% for the first quarter and 20% to 22% for the full year.

Your next question comes from the line of Joanne Wuensch from Citigroup.

ADA is going to be here before we know it. Is there anything in particular that we should look forward to there? And I'm also trying to key in on when are we going to get a line of sight on some of the clinical steps for Omnipod 6?

Yes. Thank you, Joanne, for the question. So let me maybe just tee up one of the things that we'll be sharing at the ADA, which is our -- from our -- data from our feasibility study EVOLUTION, which is around what we're calling our fully closed loop, which not all fully closed loops meet the definition of our definition. And I think it's important, I'm going to spend a little bit of time on this quickly, and then Eric will cover the others. We are designing as the market leader with our big eyes focused on the underserved type 2 market in the United States, where we have 5% penetration and there's 5.5 million people on insulin, that we would like to be on AID therapy since the ADA guidelines recommended AID therapy as the standard of care. We have designed our fully closed loop to address the biggest barriers for those patients with type 2 to get on to AID therapy. It starts with our algorithm, which will be including no user intervention. It requires no dosing. It has no meal time interactions, no adjustments while the Pod is worn. There's 2 other areas that are really important to the type 2 user base who -- one is the clinicians. And the clinicians, this will require no defined settings at start, which is a big barrier right now to the primary care prescribing base that just don't have the time to go input all of those settings. And then third, Joanne, the big unlock is patients don't have to do 2-hour training. This is something that they can initiate on their own. So our combination of really modernizing the training so that they can do it at home on their own time without 2 hours, really unlocking prescriber adoption, not having to put in settings, really important for the primary care audience, which is really who's going to be managing patients who have type 2 diabetes. And then third, really a very CGM-like experience for people with type 2 diabetes. So we're going to be sharing our data from our feasibility in -- at the ADA. But in addition to that, we have some -- our third-generation algorithm and Omnipod 6 that Eric will touch on.

Joanne, just building on Ashley's comments about what's coming at the upcoming congresses. So at ATTD, we'll be showing the evolution data, as Ashley just described, on our way towards that truly transformative fully closed loop system to unlock primary care. We'll also be showing some health economics data showing favorable outcomes in ER visits for the unique fully exposable experience that is Omnipod as compared to tube pumps. So really excited for what's coming at ATTD. Looking ahead to ADA, that's where we'll be publishing the pivotal results from STRIVE. That's the pivotal study that supports Omnipod 6, excited to be reporting that out. And in addition, Ashley mentioned this earlier, but there are more independent third-party studies comparing clinical results of on-market AID systems coming out. And in 2 recent of those, Omnipod has shown unsurpassed A1c and similar time and range to those reporting time and range using an iCGM sensor. And so one of the other things that we're paying attention to is that it's really important to interpret clinical data based on A1c, and it's hard to compare across studies that don't use an iCGM sensor for time and range. And so there's more of those studies coming out, and you'll see us talking about those too.

Your next question comes from the line of Richard Newitter from Truist.

Congrats on the quarter. Maybe the first one, just your type 2 mix, I think you said you exited the year at about 40% of new patient starts. I guess that would seem to imply that your type 1 segment maybe saw moderating growth leveling off in the single-digit range. I guess, is that the right way to think of it going forward? And if so, what is that? Is that share? Is that just the market kind of starting to moderate and we're getting near maturity? And then I have a follow-up.

Yes, I'll start and maybe Eric can add. So yes, we had very strong type 2 performance in the fourth quarter, and there was a continuation of that strength throughout the year. We had record new customer starts for both U.S. and international, both year-over-year and sequentially. To your point, Richard, type 1, it grew nicely year-over-year, and it was comparable to the third quarter, which was a record quarter for us in NCS. The level of penetration, obviously, in type 1 is higher than type 2. And as we continue to bring AID into those markets, you will see accelerating growth in type 2, just given that it's 5% today versus type 1 at 40% penetration of AID. But we continue to source a lot of our volume from MDI, as we talked about, 85%. And that's really our strategy to drive that penetration in those customer segments and internationally, which is also still very underpenetrated. Eric?

Yes, Richard, thanks for the question. I think as Flavia described, type 1 in the U.S. is more penetrated and the level of new customer starts in the market is high. And so it continues to be a significant driver of growth. Ashley described it well. We've got a balanced growth portfolio and type 1 is a big part of that. Type 2, the level of new customer starts in the market has been low, and we are accelerating that as we launch Omnipod 5 with type 2 and did so over the course of 2025, which is why you saw mix grow. You also saw our type 1 new customer starts outside the U.S. grow significantly year-over-year. And those 3 levers, U.S. type 1, U.S. type 2, international type 1 are going to contribute a balanced contribution to our growth over time.

Okay. That's helpful. And maybe can you -- following up to Travis' question, can you put some assumption bars or around the upper and lower ends of your range? Or maybe said another way, what would have to happen to the biggest needle mover in your assumption set to be at the upper end or above?

Well, we provided a guidance range. So to me, that is the upper and lower end of the bar that you're describing, Richard. And I think we obviously, as I said earlier, we continue to set guidance with the full intent of delivering, and this is our best outlook at this point, given where we are in the year. Obviously, if we can advance AID penetration even further and faster, that will translate into us being closer to the top end of the range.

Your next...

We have time for one more question.

Certainly. Your final question comes from the line of Danielle Antalffy from UBS.

Congrats on a strong end to the year, ladies plus Eric. So my question is on the competitive moat. Ashley, you touched on this earlier. I do think it's underappreciated. I specifically wanted to see if you could talk a little bit about the sampling at the physician's office and sort of if you could walk through how this works, like who trains the patient to ensure they get the optimal experience? And I appreciate it's still early, but what are you seeing for capture rates with that program?

Thank you, Danielle, for the question. And I guess just for context, again, I think the company is best known for just having really differentiated technology and investing ahead of the curve in supply chain and maybe pioneering this pharmacy pay-as-you-go model. And what I would like to see at the end of this year is a better appreciation of the commercial prowess that we've been building over the past couple of years. So we have been expanding our sales force. We expanded it around 25% last year. We're continuing to do that. We call on over 17,000, so full coverage of the endos, really 10,000 of the highest prescribers. And what we're evolving is our messaging, as I mentioned earlier, in addition to selling what they've come to love, which is really this differentiated technology platform that's simple and easy to use. It's why it's the gateway to the category to new users, it's easy for them to explain. It's also coming to educate on our really strong clinical performance, and we will continue that messaging in 2026. To make it easy to get people on Pod, we're really the only AID offering that can get people on a sample. So in -- right in the practice, they can go put a Pod. It's a very capital-efficient way for us to initiate trial. We've gotten a lot of really good feedback both from young children as well as grandparents around once -- it's kind of that moment of delight. Once they try it on, they get the, wow factor, and we have very strong conversion ratios. In addition to the called on universe, we also have this darling brand is what I say that I think is a bit underappreciated where we activate directly to consumer, make them aware of the category, make them aware of Omnipod 5 and people go in and ask their doctors for that. And they specifically ask for Omnipod, and that's a new category user. And we -- those then become new patients, but they also become new prescribers. And that's why you heard us talk about when we ended the year, we had 30,000 prescribers writing for Omnipod, which is up 28%. And we're going to continue that flywheel of really creating the market and creating demand for Omnipod. Thank you for the question, Danielle.

And this concludes our question-and-answer session and today's conference call. We thank you for your participation, and you may now disconnect.