Inogen Inc 2026 Q2 Earnings Call

Thank you all for participating in today's call. Joining me are President and CEO, Kevin Smith, and CFO, Jason Richardson. Earlier today, Inogen released financial results for the second quarter of 2026. The earnings release is available in the investor relations section of the company's website, along with a supplemental financial package. During today's call, we will discuss non-GAAP financial measures that we believe provide useful information for investors. This information is not intended to be considered in isolation or as a substitute for GAAP financial information. Reconciliations of these non-GAAP measures to the most directly comparable GAAP measures are included in today's earnings release and supplemental financial package. In addition, our discussion today will include forward-looking statements, including, but not limited to, expectations on our future financial and operating performance. We make these statements based on current expectations and reasonable assumptions.

Our actual results could differ due to risks and uncertainties. Please review our annual report and other SEC filings for a discussion of risk factors that could cause our actual results to differ materially from any forward-looking statements made today. Forward-looking statements made on today's call speak only as of today, and Inogen undertakes no obligation to update or revise these statements except as required by law. The company has not provided a reconciliation of forward-looking adjusted EBITDA to the most directly comparable GAAP measure because certain items that impact net income are uncertain or outside the company's control and cannot be reasonably predicted without unreasonable effort. With that, I will turn the call over to Inogen's President and CEO, Kevin Smith.

Good afternoon, and thank you for joining our second quarter 2026 conference call. Starting with the Q2 results. Q2 total revenue came in at $95.1 million, growing 3% year-over-year due to strong international growth, POC demand, and contributions from our new products, including Boxy and Aurora Mask. We believe that our continued strong POC unit volume growth of over 12% demonstrates that we continue to outpace market growth as we continue to expand internationally and gain traction with more U.S. distributors. In addition, we continue investing in product innovation and commercial leadership to expand our presence in the home respiratory care market with a long-term goal of consistently delivering high single-digit revenue growth.

U.S. sales were $42.3 million in the quarter as the strong mid-single-digit revenue growth in our B2B sales channel was not enough to offset the channel mix challenges in DTC. Results in DTC reflect a market shift where HMEs are prescribing POCs from day one, and in turn, HMEs are our largest and most strategic funnel. It is important to note that in total, the U.S. segment unit volume was up high single digits, indicating continued strong interest in our products and bolsters our confidence in our strategy. This quarter, we also increased our investment in the B2B sales force, and the team is working across the commercial organization to sharpen execution and align priorities. That investment is already starting to show a return. We significantly increased the number of U.S. customers moving through the B2B sales channel sequentially over Q1.

The cost of ownership case we're making to HMEs is compelling. An eight-year useful life against a five-year industry standard best-in-class serviceability and a growing body of real-world outcomes data. In addition to POCs, our two new products, Boxy and Aurora, continue to receive positive feedback from patients, physicians, and caregivers. We are starting to build inroads in these markets and are pleased with the progress to date. I remain excited about elastic growth with our core business as we bring new innovation to market. On rental, as more patients enter the long-term oxygen therapy pathway through HMEs with a POC, the traditional funnel for rental is narrowing. While this creates a tailwind in our B2B channel, our direct sales channels are feeling pressure. We are managing the rental business with discipline, balancing growth against profitability.

At the same time, we remain committed to ensuring every patient who wants an Inogen device can get one. International was again a standout. Revenue of $41.3 million grew 15% year-over-year. A mid-teen digit expansion sustained across geographies and commercial initiatives. We are penetrating in existing countries and expanding further across Eastern Europe and Latin America while our teams are deepening distributor relationships. Q2 was continued evidence of a repeatable model. While we do see the timing of select distributor purchases impacting the second half, we expect the trajectory to continue to fuel further growth over the long term. One example of our continued global expansion is the Rove 6 portable oxygen concentrator launch in Canada. Canada is a large opportunity with roughly 2 million COPD patients.

This follows Rove 6's launch in Brazil last quarter, which continues to perform in line with our expectations. These successive launches are the execution of a deliberate international expansion strategy, entering new geographies, building upon established distribution relationships, and extending Inogen's reach to patients who currently have limited access to high-quality portable oxygen therapy. Profitability is an active priority at Inogen, and we are diligently executing toward it. Our adjusted EBITDA this quarter was $2.4 million, reflecting 15% year-over-year improvement. At the same time, we are conducting a thorough review of our P&L. We have been examining every line of the business with a clear mandate to ensure our cost structure is aligned with our growth priorities and that we are deploying capital to drive growth, expand into large growing markets, or expand the value proposition of our market-leading products.

That work is underway. We will share more as it gains progress. Our approach to capital allocation also reflects a simple principle. Every dollar we spend must contribute to building a stronger company and generating sustainable shareholder returns. In practice, that means investing with conviction where we see clear returns, such as the sales force expansion, HME channel development, international market entry, and adding higher-growth, margin-accretive products in adjacent markets. Importantly, we generated $2.9 million of operating cash flow and ended our second quarter with $107 million in cash equivalents, marketable securities, and restricted cash, reflecting our strong capital position and ability to continue investing in innovation and long-term growth. We continue to operate with no debt. Innovation remains central to how we generate long-term value at Inogen. This quarter, we made meaningful progress across our pipeline.

Specifically, Boxy expands our core oxygen product portfolio as a high-quality alternative for home oxygen therapy. To date, we've shipped more than 5,000 units. We continue to receive positive feedback from patients and increase traction with our HME partners. Beyond the encouraging early commercial performance, Boxy addresses an attractive market opportunity. We estimate the SOC market has a TAM of $300 million in the U.S. Importantly, stationary concentrators are a foundational part of oxygen therapy, as virtually every patient who uses a POC also has a stationary oxygen concentrator in the home. By expanding to both POCs and SOCs, we are able to serve a larger portion of the patient journey, deepen relationships with U.S. B2B partners, and capture additional value within our core respiratory care market.

At the same time, we are building traction with Aurora CPAP masks. We are encouraged by the strong early adoption, having more than doubled our customer count sequentially. We continue to expand the Aurora pipeline and convert those opportunities. We expect this momentum to continue. The clinical evidence confirms what our commercial teams have been hearing. At Sleep 2026 in Baltimore in June, we presented the full results of a 90-day in-home study evaluating experienced CPAP users who are already satisfied with their existing mask. That is a deliberately high bar, as these are not dissatisfied patients looking for an alternative. Yet the data showed that they overwhelmingly preferred Aurora. The discussion at Sleep, the conversations that followed, and most importantly, the growing traction in Aurora reinforce our conviction. We have a product people want to use and the clinical foundation to prove it.

Our U.S. B2B sales reps are deepening provider conversations. We expect Aurora contributions gradually increase throughout the rest of the year. We estimate the U.S. CPAP mask market at approximately $2.2 billion, growing at a high single-digit rate. Every point of market share is roughly $20 million of potential annual revenue to Inogen. We continue to execute the evidence-driven, HME-focused commercial strategy we have already put into motion to make this market meaningful for us. We are also actively building the clinical and commercial foundation to scale Simeox. We estimate a U.S. TAM of approximately $500 million in non-cystic fibrosis bronchiectasis alone, growing at a high single-digit rate. The path to access that vast market is through CMS reimbursement. Our INPACT200 trial's enrollment is progressing on track, with the goal of providing CMS and payers the clinical and economic rationale to cover this differentiated therapy.

In China, we completed enrollment and achieved last patient's last visit for the SCOPE Study. We expect statistical analysis results later this year. China represents a significant long-term opportunity in respiratory care, and we are moving methodically through the regulatory pathway to access. While we invest aggressively in new products, we are equally committed to deepening the clinical and scientific foundation of our core oxygen therapy business. I want to highlight our recently published manuscript in the ERJ Open Research, where we introduce a simple oxygen therapy assessment tool known as the Questionnaire for Oxygen Therapy Evaluation, or QUOTE. Developed among 14 eminent pulmonologists across the U.S. and Europe, QUOTE is a clinical assessment tool designed to improve how patients on long-term oxygen therapy are evaluated and managed. This manuscript demonstrates that Inogen's contribution to respiratory medicine extends beyond our device portfolio.

It strengthens our scientific credibility in oxygen therapy, deepens our engagement with key respiratory thought leaders, and advances the standard of patient assessment and management in the global long-term oxygen therapy market. The early response has been striking. Within days of publication, we received requests for translation into additional languages and interest in further development, validation, and deeper psychometric evaluation. The level of immediate engagement from the global respiratory community speaks to the unmet need this tool addresses. Beyond our current portfolio, we continue to invest in our innovation pipeline, advancing digital health capabilities designed to enhance patient engagement, connectivity, and clinical insight. I would like to take a moment to welcome Andy Reding, who joined Inogen last month as Chief Operating Officer, a newly created role that reflects the operational scale and executional demands of this next chapter.