Good day and welcome to the Inspire Medical Systems' Fourth Quarter and Full Year 2018 Earnings Conference Call. Today's conference is being recorded. Following the speakers' remarks, we will have a Q&A session. At this time, I would like to turn the conference over to Mr. Bob Yedid. Please go ahead, sir.

Thank you for participating in today's call. Joining me are Tim Herbert, President and Chief Executive Officer; and Rick Buchholz, Chief Financial Officer. Earlier today, Inspire released financial results for the fourth quarter and full year ended December 31st, 2018. A copy of the press release is available on the Company's website. I'd like to remind you on the call that management will make forward-looking statements within the meaning of the Federal Securities laws. All forward-looking statements, including our discussion of operating trends and our expectations of future financial performance, including full year 2019 guidance and our expectations with regard to near and long-term growth potential of our business are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ. Accordingly, you should not place undue reliance on these statements. See our filings with the Securities and Exchange Commission, including our Annual Report on Form 10-K filed with the SEC today for a description of these risks and uncertainties. Inspire disclaims any intention or obligation, except as required by law to update or revise any financial projections or forward-looking statements whether because of new information, future events or otherwise. The conference call contains time sensitive information and is accurate only as of the live broadcast today February 26th, 2019. And with that, it's my pleasure to turn the call over to Tim Herbert, CEO. Tim.

Thank you, Bob. And thanks everyone for joining us today. I am pleased to welcome you to our fourth quarter and full year 2018 earnings call. We ended the year with significant operational and financial momentum that has carried us over into the start of 2019. I'll provide you with the details around what is driving our continued strong performance and our CFO, Rick Buchholz will follow with a comprehensive review of our fourth quarter and full year 2018 financial results. Following this we'll open up the call for your questions. As I like to do at the outset of these calls, I want to reinforce the mission of Inspire which is to look to deliver positive and consistent patient outcomes for those with untreated, obstructive sleep apnea and to increase the awareness and adoption of Inspire therapy in the United States, in Europe as well in new regions such as Japan. Before we get to the operational results, I would like to touch on the successful follow-on offering we completed in December 2018, which raised $69.8 million of net proceeds for Inspire. Importantly, this financing will enable us to hire additional sales and marketing personnel, primarily in the US and to expand commercial programs in Europe and in Japan. In addition, we will accelerate our investment in product development to further enhance our technology platform. We are grateful for the support of all of the investors who participated in the offering and we remain focused on creating long-term shareholder value. So, regarding our performance in 2018 we continue with our balanced commercial growth strategy, which is primarily focused on the US market with the objective of first increasing patient flow at existing centers and secondly, training and opening new implanting centers. In addition to our focus on the US…

Thanks, Tim. We are extremely pleased with our financial performance in the fourth quarter of 2018. We continue to demonstrate strong execution across our business and remain focused on expanding our team to support the growing demand for Inspire therapy in the United States and Europe. For the fourth quarter ended December 31, 2018, total revenues were $16.6 million, which is a 66% increase over the $10 million generated in the fourth quarter of 2017. US revenue in the first quarter was $14.8 million, a robust increase of 77% from the $8.4 million, generated during the same period of the prior year. This growth was due to continued market penetration in existing territories, the expansion of our US sales reps in new territories, increased physician and patient awareness of our Inspire system and a greater number of prior authorization approvals. Our US average selling price remained consistent at 23,300 for both the fourth quarter of 2018 and 2017. In the fourth quarter, European revenue increased 11% to $1.8 million from $1.6 million in the fourth quarter of 2017. Approximately 85% of the increase was volume-driven primarily by the activation of new sites in Germany and the establishment of reimbursement in the Netherlands, while 15% was attributed to a price increase with the introduction of the new neurostimulator in Europe in the second quarter of 2018. During the fourth quarter, the European average selling price was 21,500 compared to 21,100 during the fourth quarter of 2017. Our geographic mix of revenue in the quarter was 89% in the US and a 11% in Europe, with a slightly greater revenue concentration in the US market as compared to the second and third quarters of 2018. The gross margin in the fourth quarter was 80.7% compared to 81.1% in the fourth quarter of…

[Operator Instructions] Okay. And we will take our first question from Richard Newitter. Please go ahead, Mr. Newitter.

Hi. Thanks for taking the questions, and congrats on an excellent year. Maybe just the first situation in your 2019 outlook here 32% to 38%. It's a very healthy growth rate, I guess, maybe give us a little color on any cadence factors we should be thinking about as you move through the year and what contemplated with respect to Blue Cross Blue Shield and the Aetna ramp?

It's, Rich. We have several factors that really played role in our guidance for 2019. First of all, we had a really strong 2018, which we're very excited about and we will continue to work our cadence, if you will, we will continue to work on prior authorization submissions while in parallel we work to expand our coverage policies. And so with that, we've increased our hiring cadence of territory managers four to five on a quarterly basis and increased our number of centers that we plan to add as we mentioned. And so we've also gotten recent news in getting eight Blue Cross Blue Shield plans covered since we received deposit assessment on January 7, from Evidence Street, but we know it does take time to find those patients to make sure we have centers up and running in those coverage policy areas, if you will, as well as making sure territory managers in those areas as well. So, as Tim mentioned, it might take five to six months with getting those policies to really take hold throughout 2019.

Okay. So progressing through the year and Blue Cross Blue Shield, it's probably not really factored in meaningfully to those numbers until the back half, what I think I'm hearing. The second question I had, just -- do you have any statistics or data on the -- the number of prior authorization submission to currently, what percent are comprised by or fall into the Aetna and Blue Cross Blue Shield insurers? Just trying to get a sense for kind of what percentage of your kind of your backlog, so to speak, or your pipeline is comprised of Blue Cross Blue Shield and Aetna patients?

Fantastic. Thanks, Rich. So the Aetna as you recall prior to issuing the positive coverage policy back in July of 2018, and then we have those re submission that dominate a lot of the approvals. In fact, a third of our growth in, the third quarter of last year was Aetna. And so we track that closely and one thing -- Aetna right now it's a rough number event, but it's probably in the lower mid teen percentage of approvals is what is today, and that's pretty good. Because that start to increase over the prior year, which was basically zero, right, because Aetna wouldn't do any prior authorization. The good news with Blue Cross Blue Shield, they have been approving all the equipment taking patients through second level appeal even third level appeal, which we called a EMR, external medical review, but what these new coverage policies are going to do is significantly reduce the time for those prior authorization approval. And so the team is working very closely. We also have several consultants working with other regional plan to get those policies written such that in the back half of the year that we can drive down that review cycle time and really have an impact on the year and that's what we are pushing for as kind of the key driver of the cadence that we want to implement. But it's really, it comes at about the timing for those plans to write the policies, get them implemented and get them active with the centers.

Okay. Thanks a lot.

[Operator Instructions] We will take our next question from Chris Pasquale from Guggenheim. Please go ahead.

Thanks. And congrats on a great quarter and some outstanding progress. First Tim, can you update us on what you're seeing from, Aetna today in terms of their turnaround time on submissions, and you mentioned the bolus of Aetna submissions that went in the third quarter, did that lead to a subsequent bolus of approvals this quarter or most of those submission is still in process?

Thanks, Chris. The Aetna, once the policy came out, remember it took a while, with the logistics, because they had updated policy and then they had to update codes within the policy. And then we needed that the trickle-down to the centers. By about the middle of the third quarter, we pretty much have that stabilized and we are able to submit and the net result of that. Well, a third of our growth in approvals with Aetna cases in the third quarter, we continue to see that cadence happened now. We believe that most Aetna cases get approved. And on average less than five days, because they are all approved at the prior authorization phase and they're not required to go to approval. And we kind of look back at the fourth quarter and estimate that the number of approvals from Aetna make up about 15% of our approvals in the quarter. So it does have a significant impact. We're going to continue to drive that going forward. And it's really exciting for Aetna and the Aetna patients and their policy, I think really had a positive influence on Evidence Street, which in turn of course has such influence overall the Blues plans and so it's really put in the wheels in motion and really getting the policy train moving.

Thanks. And then you started to touch on this with the answer to Richard's question, but I think there's a little bit of confusion, given that Aetna was not paying for cases at all, so is kind of going from nothing to something and some of these other plans were albeit through a protracted process just how incremental these positive coverage decisions really are. Can you spend a minute on how having coverage impact some other things like physician engagement, patients willingness to go -- to even begin the process and things like that. Or you are seeing a benefit even though these plans, maybe were technically paying for the procedures previously.

Let me answer that in a couple of different ways. First, let's go to the centers and look at, what the physicians are -- support team does everything, we tend to kind of streamline the process, but the centers are the ones that really have to submit the prior authorizations and the physicians are the ones that have to fight for the patients with the insurance companies. So, it's really important that this streamlined process is going to make it easier for these physicians, and it's going to reduce on these physicians, because working with the patient to go through or working with an insurance company to go through three levels of appeal. And as we mentioned, the time to approve it, went from a 124 days to less than 90 in just one year, and we believe that number 90 is going to significantly reduce again here in 2018 and the benefit from that is going to be a reduced amount of physician fatigue in dealing with insurance and prior observation that's not what physicians want to do. They want to treat patients. The second part is even patients themselves, when they come to our website and if you go to our website you stated very large, you're going to see a little chat line pop up and as could you have any questions in regard to Inspire therapy and the number one question that we get asked is, does my insurance Company cover this. And so it's important to be able to like, let patients understand that. Yes. Insurance companies will cover this, but as you remember which we went through some of the cadence of the number of dropouts that we had through the appeal process and that's the -- again that's patient fatigue will take so long to get an insurance approval. They are fatigued and they withdraw themselves from the process. And these coverage policies are going to have a significant impact on reducing that dropout rate because patients can now get approved in just a few days. So it's just like we did -- we're going to continue to monitor the impact that this Blues plans will have in the next few quarters. But more importantly, we will also be putting the pressure on other insurance companies at right positive coverage policies.

And we will take our next question for Jon Block from Stifel. Please go ahead, sir.

Great. Thanks and good afternoon. Tim, what we -- sort of have your -- let me just ask on the policy today on the coverage policy from Emblem. If you can elaborate a little bit on that decision is that consistent with somebody earlier policies from the Blues, in other words BMI of less than or equal to 32, did it also had of a pediatric indication and then sort of a follow-on, can you talk about some of the Blues that did come with a pediatric indication. Maybe to what extent that was an upsized surprise for you? And then I've got a follow up.

Okay. Fantastic. Several questions in there. So let me kind of walk through those in detail. Let's go back a little bit to Evidence Street. And Evidence Street came out with a favorable assessment, and when they did their review, they only included the first FDA approval letter for Inspire. And you cannot go way back, but our initial impact was for AHI range of 20 to 65 and subsequently we had a PMA supplement that lower that AHI down to 15. Evidence Street didn't incorporate that ended the review. So, our Kathy Sherwood has been working with Evidence Street to make sure that they have the necessary information, Evidence Street has recognized that. And we think that they're going to come back with an update, maybe mid-year that will get that AHI back down to 15. It was not their intention to just slight to that 20, but they wanted to include the full indication from the FDA. So we expect that that will come back down to 15. The second step on that, what you assume with a lot of the Blues policies, if they're coming out with a BMI of 32, now Evidence Street as itself came out and they had a BMI less than 35. So some of the Blues have tightened up the parameters there. And we continue to work with investigators to look at the data from patients between BMI of 32 and 35. We'll continue to publish data on that. From our standpoint, we're very excited to have these policies and with a BMI less than 32 that happens to match the BMI that we use during the STAR trial, which is a pivotal trial in New England Journal of Medicine. But since then we've moved that BMI higher up, it's important to…

Okay. Yeah. You did a much better job of answering that than I did of asking it. So, thank you. The second question, just in the K, you've -- that advertising expense this year was $7.8 million. It was up from $5.5 million last year, but you've got almost $190 million in cash. You're starting to get some of these payers coming on Board. Can you just talk about the outreach in increasing awareness. So, we're going to see sort of a methodical increased advertising expense or is that something Tim, with the balance sheet and the payors coming on Board that you can start to accelerate pretty meaningfully. Thank you.

Hey Jon, this is Rick, I'll take that one. So yeah, we did increase in 2018. We expect to increase, maybe a low but more aggressively in 2019, given that we are increasing the number of centers that we're adding as well as territories. And so when we do add those new territories, we will do radio and social media strategy and programs in those new territory. So, we will increase that ratably, but we will continue to have that, what, I call kind of controlled, sustained growth in adding reps and territories and centers to maintain those good patient outcomes. And so we're going to continue to be methodical even though we have a strong balance sheet.

[Operator Instructions] Okay. And we will take our next question from Lawrence Biegelsen from Wells Fargo Cisco.

Good afternoon, guys. Thanks for taking the questions and congrats on the really strong quarter and year. I apologize if I missed this but the category one CPT code for the sensing lead, I had emailed to me, it sounds like there was a change there. Could you talk a little bit about, it sounds like you pulled the application. Can you talk about why, what the next steps are.

Answered already. Thanks. But the--We did submitted. It was then the agenda. We were working very closely with the American Academy Otolaryngology which and they ENT society and if they did submit the application. They did have strong representation at the meeting and Scottsdale, to be able to increase. They did have time to discuss it with the AMA committee meeting members prior to the meeting and there is question still outstanding. The purpose of the code, the understanding of the code and then we look at the statistics and the metrics in the usage of that code, as compared to the growth rates projected and discussed by Inspire. And there is a discrepancy in the numbers again, I and mentioned earlier, I think, we think the key reason is, a lot of centers just don't filed that because is a Category 3 called the railroads many payment. And so that's a creates a little bit of a challenge. So Category and that in itself creates a little bit of a problem, both the system has a payment and working to convert those are always difficult. So the AAO [indiscernible] that and we concurred, that the right thing to do is let's look back up again and spend a little bit more time educating and not try the first still having this code rejected, because then we have difficulty rebounding and bringing that back to, so they withdrew the code and we'll come back and resubmit it to the AMA in the meantime, we'll continue to educate the AMA members and the importance of it from the hospital Standpoint, it has no impact on their payment level. The payment level as all based on the primary code which is 64568 and the Mazda average Medicare payment this year is 27,700. So it's a good payment level to support not only the device, but the capitated for performing the procedure, the only person who is affected by this non-vote, if you will, or a day, then the code not being converted today is the physician pay is that this under the surgeon payment. And so there is still being paid their normal surgical fee for 64,568. But the category three code will be slidely delayed again and we that might increase attainment about six to eight hundred dollars per procedure again. It's only the surgeon payment, we don't believe it's going to have any significant impact as the majority of our procedures today outperformed at high academic centers or the large private centers whereby the surgeons are salary based anyways. So we're going to continue to work with the ENT society, but don't think it's going to have any impact.

Thanks for that. Just curious, I'm Wendy plant, you said you're going to resubmit Tim. When do you plan to resubmit and then you know what does the guidance assume about additional payer coverage in 2019 and bigger ones like that and United, where you are on those two. And just lastly, Tim reimbursement in Japan, how is that going to remind us kind of the timing there. Thanks for taking the questions.

Thank you, Larry. Okay, makes. I think I got all those. So, there is one more submission left this cycle. I think there is actually two, but we won't be ready for the first one. We're going to continue to work with the, if we will be ready for, I think it's a November submission. I'll have to track that it may be likely that we're going to wait till the next cycle before we resubmit that. As far as guidance go, we like our guidance set up using our prior authorization model. And as I mentioned, it's going to take five, six months to be able to get these policies -- working purely logistics of the payers and the centers and we're going to continue to work their cadence to drive more and more prior authorization -- I'm sorry, more and more positive coverage policies throughout 2019, Kathy has her team along with three contractors with assignments to all the individual Blues plants as well as some of the larger plants. So we are in communication with some of our favorites with United and Cigna and Humana and the other non-Blues large payers, and we're working with all parties to make sure that they're educated on the clinical evidence we have published. And we continue to publish additional information. So, our guidance really hasn't driven a lot by two main more coverage policies that in are play. But we are assuming and expecting that we will get more coverage policy this year, which will really have more of an impact in 2020 and beyond. Did I answer all three of those questions? What was the third one?

That's clear, I'd appreciate. Yeah, if you didn't buy let it upfront in the prepared remarks, otherwise we can take an implied.

Let me comment on Japan. We do have the approval in Japan. But that approval was for our original products. And so now what we have. We submitted our regulatory submission to include the new Inspire of stimulator Neurostimulator and the new sensing lead that was just approved by the FDA recently and we did have our interactive review and questions from PMDA, which is the active way of Japan. We believe that review is growing positively and expect approval sometime this year. And with that, we'd like to do have first implants with the new products. Secondly, we're working in concert with the societies in Japan for a three society the at the working on Inspire sleep E&P and cardiovascular. They have formed a committee over with the oversight from PMDA again that's you FDA Japan to help launch Inspire and established therapy guidelines. Those guidelines have been drafted. We expect to see some of those results in the near future and the submission is twofold, one side from the company and the other side, I'm talking to regulatory and reimbursement submission our from both sides and we expect that to be submitted to the MLP HW which is the reimbursement authorities in Japan and they have also been active. So we do expect to do the first implants, but we're really looking to do a formal large in 2020.

Okay. We will take our next question from Isaac Ro from Goldman Sachs. Please go ahead.

Okay. Afternoon guys. Thank you. Just another question on the Blue Cross effect here be helpful if you could give us any sense of whether or not additional coverage you guide and in, at the end of the year was helpful to revenue and basically what's essentially trying to get a sense of what's embedded for the rest is 2019, given how much coverage gotten in the last few weeks and probably the fact that we're going to get more in short order would be helpful to try and isolate that piece.

Thank you very much. We do think the Aetna had a positive impact as we mentioned before, a third of our prior authorization, growth in the fourth quarter in the third quarter were from Aetna and those kind of reflect more in fourth quarter implant and we did have a significant number approvals in the fourth quarter, some of which have been implanted again going back to our discussion about the pace of heightened deductible plans working to get their cases done before there high deductibles reset at the beginning of the year. So Aetna is included in our guidance, we do think is going to continue to have a positive impact going forward from the Blues standpoint remember, when we talked less the, we didn't have evidence Street until just the beginning of January and then from there. The next step was to be able to work with individual Blues plans to policies and by those policies through the policy that we have to work to get them logistically implemented and organizations and with our implanting centers, so we do think it's going to be take a little bit of time to make it happen. Now the next key step to those I like is looking at developing part of positive coverage policies with some of the key is policies in some of our higher implanting territories and we are working hand-in-hand with our consultants and with the medical directors and the do policies is put in place and what we have those in place that is going to have a significant impact, but we don't have those yet and so those patients is still working through the prior authorization process and again to review cycle is less than 90 days now as compared to a 124 previously, and I think when we get near to later in the year we going to see that number significantly reduced and that's going to be the impact that can be the answer to the question that your answer and asking. We do think it's going to have a positive impact Blues policies or not. And as part of our guidance right now because we have a lot of work to do to get those implemented and to get additional policy expanded.

That's helpful. And then just to clarify for the guidance that you set out for this year, does that guidance assume you get additional favorable coverage from those other Blues and as a result, get some revenue from those from those.

Now is very important for us either it to put our guidance that we have strong confidence in and we know we can grow this. That's what our prior authorization model and we know we can get those patients approved, albeit they have to go through quite an extensive cycle time and we also don't quite know the impact of the time it's going to take to get those positive coverage policies up driving and active. As well as additional coverage policies in some of our high implanting areas. So we didn't include a lot of risk in our guidance based on the assumption that we will get those pilot those policies in place. Instead we put forward numbers that we're confident in that that we can drive with our prior authorization process.

Got it. Thanks for the clarification. If I could sneak in one more quickly on gross margin. I appreciate your comments on that third-party logistics item that presents headwind, but I'm curious aside from that what would realistically gross margin at the low end of the range to actually be down year-on-year. Just seems like there's so much momentum in the core business that you should be able to generate pretty good gross margin this year all things considered?

Yeah. We expect to be in the range of 79 to 81 Isaac and depending on the acceptance at the sensing move in the US, which initially in Europe, it's been, it's been strong and then well received. We expect to be at the higher end of that gross margin throughout 2019.

Okay. And we will take our next question from Kyle Bauser from Dougherty & Company.

Great. So, apologies if you already covered this, but can you talk about the size of the opportunity for the upcoming expanded indication for pediatrics with Down syndrome in terms of prevalent incidents and also talk about your market development efforts, and if there'll be modified for these cohorts at all. Can you leverage the same physician call points will direct to consumer efforts be modified, etcetera.

Great question now tricky to answer, so we are doing our assessment of how large that population is we think it might be a 100,000 between provide for a dollar standpoint, with OHP because we have to the market is why, but between 100 to 200 million additional market opportunity beyond our 10 billion market opportunity that exists. Now, let me comment on that. So those are preliminary market numbers suggest just putting bid, it's a different dynamic with this population that unfortunately these kids have a hard time. They just can't use CPAP and so the compliance. We to see of is very, very low and we also have a very organized group with the parent of these pediatric cases. So market, our ability to communicate with this population is going to be quite get right. And it's not going to be just like the adult population. So we'll continue to develop that right now, we're still in the clinical study. And we are developing 15 leading children's hospitals to do these clinical studies. What's important about this clinical activity, it is actually developing an installed base to be able to take care of these kids, once the therapy is approved by the FDA. And what's really encouraging is that Blue Cross Blue Shield has already written it in as part of their Evidence Street guidelines and several other policies have already picked up coverage for this population. So, it's not as large of a population that all compared to the adult untreated obstructive sleep apnea market, but it's a very important population and why, one of those. Why we do what we do reasons. But as we are closer to working with the FDA and looking at the timing of such set approval, we will be doing a lot more work done. The whole market size and what we do to make our investments accordingly into that market, and how do we communicate with the parents and have this population and are very well organized. As though the pediatric ENTs, that are those that kind of serve that population.

Thanks. That's helpful. And then regarding the Inspire app that you're developing, which will be able to communicate with the system, the Bluetooth and then allow you to view the data and the cloud. You've talked about how you'll be able to see trends between hospitals and find out which ones are doing really, really well. Can you kind of quantify how you measure the success that -- you know of course that average nightly use time of the system seems like you'd be a good and obvious metric, but I'm curious what sort of other performance metrics from the app, we might be able to capture to identify these high-performing centers.

I think our engineers are jumping up and down that you asked that question. Thank you. It's an important initiative to us. And that we have launched Inspire Cloud as you know. And it is a cloud-based patient management system, and right now the only input into the Inspire Cloud is from the physician and from the physician programmer and what we're doing is, we're just starting that platform and now we're going to start developing tools to be able to add additional information in to the Inspire Cloud, which is going to ease the physicians ability to really manage their patients. One key step on that as you mentioned, as we are currently developing the Inspire App, which will be on a patient's cell phone and they can track their own progress and they can see what their therapy grows all are , and how they're responding to those growth. And the next step, after that is to be able to interface that device with Inspire Cloud and be able to have physicians see real time how their patients are doing by uploading that data to the cloud and having the position, be able to see how is one patient doing or how all of their patients are doing. And more importantly, they can be identified and see a broader group of patients and see how their patients are comparing to other patients. And what it's all about is really driving patient outcomes, and we like to say around here that we're outcome obsessed. And we really want to keep driving outcomes and make sure that we drive consistent positive outcomes and continue to improve Inspire Cloud in this app is just one more tool to be able to track and follow the progress of our patients.

That's great. Thanks for taking the question.

Okay. We will take our next question from Ravi Misra from Berenberg Capital Markets.

Great. Thanks for taking the call. Just a couple of questions. One on the guidance, just you spoke about this compression of time to approval and then you also kind of mentioned this concept of patients fatigue. I'm just curious with some of these payer conversions are you be able to maybe re-engage some of those patients and get them re-energized for this. And as a factor, and if at all to the guidance for '19, then maybe just my last follow up would be, just on the sensing lead. Could you just help us understand, is this something that makes it understand the kind of lower profile makes more comfortable for the patient. But is it something that is able to reduced our times or kind of any efficiencies in the procedure itself. Thank you.

Absolutely. First off -- on your first question, really Aetna is kind of the example, now Aetna is a little bit more of an example. In that Aetna, didn't previously prior authorize. So, in the third quarter, we had a bolus of new resubmissions from Aetna patients which in fact were approved and that did have impact on revenue. And it's great that we're able to get those patients implanted and that's wonderful for the Aetna patients and wonderful that they're able to get the therapy. And we do think, to a lesser extent, it's going to have an impact on the Blues, because remember the Blues will approve. And I use that, we've talked about two numbers and the other number being, if we could get patients all the way through the process, we could get 74% of them approved, but our overall net approval rate was only 55%. The gap is the patient, the peak of the patients that drop out. As we develop positive coverage policies with every payer, that gap is going to be minimized, because we're going to reduce patient fatigue, because the majority of patients will be approved in very short order to -- you use the term compression of time which is exactly what we're looking for. We want that 90 days to approval to continue to go down, and make it easier for patients to get the therapy. The second question on the 43.40 Sensing Lead which previously launched in 2018 in Europe, and then we just launched it, just a few centers so far in the United States. And we'll be expanding that in the next month. It is a lower profile product, the stimulation lead -- the stimulation lead body or the wire, if you will. We use that same…

Thank you, all for joining the call today. We certainly appreciate your continued interest in Inspire and look forward to providing you with further updates throughout 2019.

Okay. And this concludes today's call. Thank you very much for your participation. You may now disconnect.