Revenue growth has decelerated sharply, with 2026Q3 revenue down 7.9% year over year at $206.7M, while gross margin held firm at 86.0% but operating margin swung from 17.1% in 2025Q4 to -13.9% in 2026Q3.
Inspire Medical Systems, Inc. (INSP) annual income statement — 10-year revenue, gross profit & net income history
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Dec'16 |
|---|
| Sales/Revenue | 880.94M | 911.98M | 802.8M | 624.8M | 407.86M | 233.39M | 115.38M | 82.05M | 50.59M | 28.57M | 16.43M |
| Revenue Growth % | -0.19% | 13.6% | 28.49% | 53.19% | 74.75% | 102.28% | 40.62% | 62.18% | 77.1% | 73.9% | - |
| Cost of Goods Sold | 121.7M | 133.22M | 122.99M | 96.58M | 66.11M | 33.28M | 17.62M | 13.64M | 10.06M | 6.02M | 3.9M |
| COGS % of Revenue | - | 14.61% | 15.32% | 15.46% | 16.21% | 14.26% | 15.27% | 16.63% | 19.88% | 21.07% | 23.77% |
| Gross Profit | 759.24M | 778.76M | 679.82M | 528.22M | 341.74M | 200.12M | 97.76M | 68.41M | 40.54M | 22.55M | 12.52M |
| Gross Margin % | 86.19% | 85.39% | 84.68% | 84.54% | 83.79% | 85.74% | 84.73% | 83.37% | 80.12% | 78.93% | 76.23% |
| Gross Profit Growth % | - | 14.55% | 28.7% | 54.57% | 70.77% | 104.7% | 42.91% | 68.75% | 79.77% | 80.08% | - |
| Operating Expenses | 743.47M | 727.8M | 643.74M | 568.49M | 389.33M | 239.97M | 153.97M | 103.3M | 60.91M | 38.55M | 29.77M |
| OpEx % of Revenue | - | 79.8% | 80.19% | 90.99% | 95.46% | 102.82% | 133.44% | 125.9% | 120.4% | 134.95% | 181.26% |
| Selling, General & Admin | 645.83M | 624.64M | 529.61M | 451.96M | 320.69M | 202.62M | 127.87M | 90.47M | 53.53M | 32.36M | 22.68M |
| SG&A % of Revenue | - | 68.49% | 65.97% | 72.34% | 78.63% | 86.81% | 110.83% | 110.26% | 105.8% | 113.27% | 138.09% |
| Research & Development | 97.64M | 103.17M | 114.13M | 116.54M | 68.64M | 37.35M | 26.09M | 12.84M | 7.39M | 6.19M | 7.09M |
| R&D % of Revenue | - | 11.31% | 14.22% | 18.65% | 16.83% | 16% | 22.61% | 15.65% | 14.6% | 21.68% | 43.17% |
| Other Operating Expenses | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -16K | 42K | -29K |
| Operating Income | 15.76M | 50.95M | 36.08M | -40.27M | -47.59M | -39.85M | -56.21M | -34.9M | -20.38M | -16M | -17.25M |
| Operating Margin % | 1.79% | 5.59% | 4.49% | -6.45% | -11.67% | -17.07% | -48.72% | -42.53% | -40.28% | -56.02% | -105.03% |
| Operating Income Growth % | - | 41.21% | 189.6% | 15.38% | -19.43% | 29.1% | -61.07% | -71.25% | -27.34% | 7.25% | - |
| EBITDA | 34.43M | 64.91M | 42.63M | -37.42M | -45.73M | -38.63M | -55.37M | -33.5M | -19.98M | -15.72M | -17.15M |
| EBITDA Margin % | 3.91% | 7.12% | 5.31% | -5.99% | -11.21% | -16.55% | -47.99% | -40.83% | -39.5% | -55.02% | -104.4% |
| EBITDA Growth % | -30.21% | 52.26% | 213.92% | 18.17% | -18.38% | 30.23% | -65.29% | -67.62% | -27.15% | 8.35% | - |
| D&A (Non-Cash Add-back) | 18.67M | 13.96M | 6.55M | 2.85M | 1.86M | 1.22M | 840K | 1.4M | 393K | 285K | 103K |
| EBIT | 27.31M | 65.83M | 58.48M | -19.91M | -42.59M | -39.84M | -54.97M | -31.08M | -18.52M | -15.76M | -17.23M |
| Net Interest Income | 15.26M | 17.4M | 23.23M | 20.56M | 3.37M | -2M | -1.02M | 1.68M | -1.43M | -1.55M | -1.25M |
| Interest Income | 15.38M | 17.54M | 23.25M | 20.56M | 5.05M | 125K | 1.09M | 3.8M | 1.87M | 203K | 57K |
| Interest Expense | 122K | 137K | 22K | 0 | 1.68M | 2.13M | 2.12M | 2.12M | 3.3M | 1.75M | 1.3M |
| Other Income/Expense | 15.06M | 14.74M | 22.37M | 20.36M | 3.32M | -2.12M | -880K | 1.69M | -1.45M | -1.51M | -1.27M |
| Pretax Income | 30.82M | 65.7M | 58.45M | -19.91M | -44.27M | -41.97M | -57.09M | -33.2M | -21.83M | -17.51M | -18.53M |
| Pretax Margin % | 3.5% | 7.2% | 7.28% | -3.19% | -10.85% | -17.98% | -49.48% | -40.47% | -43.14% | -61.3% | -112.79% |
| Income Tax | -69.89M | -79.72M | 4.94M | 1.25M | 613K | 72K | 115K | 40K | 0 | 0 | 0 |
| Effective Tax Rate % | -226.78% | -121.35% | 8.46% | -6.26% | -1.38% | -0.17% | -0.2% | -0.12% | 0% | 0% | 0% |
| Net Income | 100.72M | 145.42M | 53.51M | -21.15M | -44.88M | -42.04M | -57.2M | -33.24M | -21.83M | -17.51M | -18.53M |
| Net Margin % | 11.43% | 15.95% | 6.67% | -3.39% | -11% | -18.01% | -49.58% | -40.52% | -43.14% | -61.3% | -112.79% |
| Net Income Growth % | 126.04% | 171.77% | 352.96% | 52.87% | -6.75% | 26.5% | -72.08% | -52.3% | -24.65% | 5.49% | - |
| Net Income (Continuing) | 100.72M | 145.42M | 53.51M | -21.15M | -44.88M | -42.04M | -57.2M | -33.24M | -21.83M | -17.51M | -18.53M |
| Discontinued Operations | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Minority Interest | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| EPS (Diluted) | 3.48 | 4.89 | 1.75 | -0.72 | -1.60 | -1.54 | -2.19 | -1.40 | -1.50 | -1.30 | -1.49 |
| EPS Growth % | 134.28% | 179.43% | 343.06% | 55% | -3.9% | 29.68% | -56.43% | 6.67% | -15.38% | 12.75% | - |
| EPS (Basic) | - | 4.95 | 1.80 | -0.72 | -1.60 | -1.54 | -2.19 | -1.40 | -1.50 | -1.30 | -1.49 |
| Diluted Shares Outstanding | 28.93M | 29.76M | 30.54M | 29.3M | 28.07M | 27.26M | 26.07M | 23.8M | 14.58M | 13.49M | 12.46M |
| Basic Shares Outstanding | 28.93M | 29.37M | 29.76M | 29.3M | 28.07M | 27.26M | 26.07M | 23.8M | 14.58M | 13.49M | 12.46M |
| Dividend Payout Ratio | - | - | - | - | - | - | - | - | - | - | - |
Quick answers to the most common questions about buying INSP stock.
For fiscal year 2025, Inspire Medical Systems, Inc. (INSP) reported total revenue of $912.0M. This represents a 5451.7% increase compared to $16.4M in 2016.
Inspire Medical Systems, Inc. (INSP) is profitable, generating $145.4M in net income for the fiscal year ending 2025 with a net profit margin of 15.9%.
Inspire Medical Systems, Inc. (INSP) reported an operating income of $51.0M, resulting in an operating profit margin of 5.6%. This margin reflects the operational efficiency of the business before interest and taxes.
Inspire Medical Systems, Inc. (INSP) generated $778.8M in gross profit for the year, representing a gross profit margin of 85.4%. This demonstrates the company's core pricing power and production efficiency.
Key Metrics
Top Statement Risk
Margin Recovery Execution Risk
Metrics are mathematically derived from official filings.
Revenue Growth Decelerating After Peak Quarter
According to reported quarterly figures, INSP's revenue growth has moderated sharply, with the latest quarter showing a 7.9% decline in revenue from the prior year while sequential revenue reached $206.7M in 2026Q3, versus a peak of $269.1M in 2025Q4 driven by year-end deductible timing.
The Q4-weighted seasonality in the 2025 figures inflates year-over-year comparisons, so the sequential trend in 2026 is the more informative signal. Revenue has held in a relatively narrow $200M to $207M band across the three most recent quarters, which suggests demand may be plateauing at current implanting-center utilization levels. Investors should monitor whether referral pull-through and Inspire V adoption can reignite volume growth rather than assume the prior double-digit trajectory will resume.
Gross Margin Holds Above 85 Percent
Based on reported figures, INSP sustained gross margins between 85.5% and 86.6% across recent quarters, with the latest quarter at 86.0%, indicating that pricing and device cost structure have remained resilient through the revenue slowdown.
Stable gross margins despite volume softness suggest limited pricing pressure and a proprietary cost base that is not easily eroded. This strength implies that the profitability problem lies below the gross line, in operating expenses rather than manufacturing economics. Because gross margin alone does not drive earnings, the durability of this figure matters most as a foundation for eventual operating leverage.
Operating Leverage Reversed by SG&A Intensity
As reported in financial statements, INSP's operating margin swung from 17.1% in 2025Q4 to a negative 13.9% in 2026Q3, as SG&A held near $184.4M against softening gross profit of $177.9M.
Operating expenses appear to be scaling in the wrong direction, with SG&A remaining elevated even as gross profit declined, which indicates negative operating leverage. This pattern is consistent with heavy direct-to-consumer and sales-force spending that has not yet translated into proportional volume. The key question for analysts is whether SG&A can be reduced toward a level consistent with the revenue base, a development that warrants further investigation.
Q4 Net Income Driven by Non-Operating Items
Based on INSP's reported figures, 2025Q4 net income of $136.1M substantially exceeded operating income of $46.1M, suggesting that a large portion of the reported profit may stem from tax or non-operating items rather than core operations.
The gap between operating income and net income in the fourth quarter of 2025 is too large to attribute to routine operating activity, which points toward a possible one-time tax benefit or other non-operating gain. Excluding this period, net income has oscillated near breakeven, indicating the underlying earnings base remains thin. Investors should treat reported EPS with caution and focus on operating income trends to assess sustainable profitability.
Persistent Losses Challenge the Growth Narrative
According to recent reported results, INSP posted a $0.84 diluted loss per share in 2026Q3 and a 2026Q2 EPS of $0.01 against a $0.13 estimate, which raises questions about whether the company can convert its gross margin strength into durable earnings.
The bear case centers on the possibility that revenue growth has structurally slowed while cost commitments remain sticky, leaving the company unable to reach sustained operating profitability. Stock-based compensation of $26.9M to $41.7M per quarter further weighs on GAAP results and warrants adjustment when assessing cash-generating capacity. Raising guidance despite an EPS miss may reflect confidence in top-line capture, but it also places pressure on margin recovery that has not yet materialized.