So, again, we’re going to be a little careful with that population to make sure we set expectations correctly. But high AHI is a go high, or the pediatric populations to go, and then the BMI we’re going to be a little bit careful. As far as the consumer spending, we don’t see that really affecting our business. The key to it is patients with untreated moderate to severe obstructive sleep apnea, let’s take that a step further. Patients who have been diagnosed and have tried CPAP, so they know the benefits of positively addressing their disease, yet not being able to be treated with CPAP. Those are the patients that are pretty motivated to get Inspire. And once they get into the process, I don’t think we have many people that drop out, because of the economic reasons, whether it be the co-pay with their private insurance, or I think the estimate from Medicare, it’s about $800 out of pocket for a Medicare procedure.
So we don’t see patients really walking away because of that expense. Thanks, David.
Operator: Thank you. And I show our next question comes from the line of Anthony Petrone from Mizuho Group. Please go ahead.
Anthony Petrone: Good afternoon. Thanks for getting us in here. So staying on the coverage theme, there’ll be question one, and then one on GLP-1s. Tim, when you think about Aetna and Humana, and you talked about AHI up to 100, and then pediatric, BMI a little tricky, I mean, is that something that you’re already seeing here in November? And so i.e., is it a 4Q phenomenon where that can sort of boost volumes in 4Q or is it more of a 2024 event? And, again, if you can quantify how large of an opportunity you think, just getting the commercial payers onboard with FDA label, how much of a shot in the arm of growth does that represent? And then quickly, just on GLP-1, Eli Lilly has a study next year, the SURMOUNT-OSA study, and a lot of talk on this call about certain percent of the patients are strictly weight.
Some of them are anatomical, you mentioned tongue collapse, lateral-wall collapse. What are you expecting out of that study? Do you think we could see that nuance where maybe it’ll prove out that a GLP-1 is really not going to be the biggest driver of reducing AHI or perhaps it will be? So maybe just some thoughts on that study next year. Thanks.
Tim Herbert: Yeah, absolutely. Yeah, let’s go back to the coverage first. I think with the high AHI; those are patients that have been trying to get Inspire already. Many patients get stacked up. Remember the old days, we used to do a prior authorization, and then once denied, we’d have to submit in a first appeal, and if that was denied, we’d go to second appeal, then we’d have to go to an external medical review, which was an independent arbitrator. The problem with the high AHI before the approval is, those patients would have to go through that process. Now, with Aetna and some other payers who don’t allow prior authorization, they just don’t have that ability going forward, same with Medicare. So these coverage is going to really help them a lot.
I think you’re already going to see some of those transition in during the fourth quarter, but certainly further into 2024, but we’re already seeing those patients coming through. From a pediatric standpoint, almost a whole new program, because this is about brand awareness and making sure that the pediatric physicians and the families really understand about Inspire, and it’s kind of more of a market development play. So I think longer-term, that’s probably more of a 2024 and increase going forward there, but really a positive market to be in, and we’re going to want to continue to expand that into other indications in the pediatrics’ groups and people that we can help along. GLP-1, expectations of the SURMOUNT trial. I think we’re looking at maybe some of the early data will get released in the spring.
I think maybe it’s going to be a little bit more of a detailed readout in the July timeframe. What we expect from that, when we’re able to look at that study and look at the demographics of the study, the average BMI, the mean BMI is 40, and the mean AHI is 50. And if you kind of look back at all the other studies on weight loss, even with the significant reduction in BMI, which would be great if all those patients achieve it, it’s still not going to be to a point where they’re going to have a clinically relevant reduction in AHI. We read through the detailed protocol, then there’s only so much detail we see, but it is a detailed randomized study. It is complex. But it only needs to show us statistically significant change in AHI as compared to placebo.
So it’s not as robust of a study that can really show clinical relevancy. And so we expect that they’ll probably show a statistical reduction. But, again, we think that if the patients are able to lose that weight, they comply into the drug and keep the weight out that they will, in fact, become close to the Inspire indication, which is, we believe, is really a positive. On the same token, there is two arms in that. There’s a CPAP arm and there’s a non-CPAP arm. And that’s been a discussion that’s been kicked around to on, what would these drugs do when we get on the market, and we’ve queried a lot of our physicians. In fact, we’re working with some of our physician groups to really understand, how GLP-1s are going to affect our market going forward and how it can affect the patient population.
And some of our doctors, in fact, not only longitudinal managed patients, but they also have a weight loss clinic. And they have patients already come in who either with bariatric surgery and those with GLP-1s have lost weight and now find themselves in a position where they have tongue-based collapse to be treated with Inspire. So we’re going to continue to build on that evidence as we continue to build forward. And the other side to it is, I think people talk about will – people just start with GLP-1s at wait, until they get onto CPAP and we’re not seeing that either. I think you heard, [Mick and Reshma] talked about this a little bit too. We’re seeing patients going to start therapy at the same time they get diagnosed or prescribed GLP-1s, and by the time that they may be not compliant to CPAP and they get to Inspire their Lordy to be down that pathway.
So, again, we think GLP-1s are going to be complementary to our business. And I think when you see this data coming out, it’s going to show more evidence to that. And we’re going to certainly be there to help those patients out if they qualify and we’ll continue to track this very closely.
