管理層發言
Good day, everyone, and welcome to Senseonics Fourth Quarter and Full Year 2025 Earnings Call. Please note, today's call will be recorded. It is now my pleasure to turn the conference over to Jeremy Feffer from LifeSci Advisors. Please go ahead.
Thank you. This is Jeremy Feffer from LifeSci Advisors. Before we begin today, let me remind you that the company's remarks include forward-looking statements. These statements reflect management's expectations about future events, operating plans, regulatory matters, product enhancements, company performance and other matters and speak only as of the date hereof. These forward-looking statements involve a number of risks and uncertainties. A list of the factors that could cause actual results to be materially different from those expressed or implied by any of these forward-looking statements is detailed under Risk Factors and elsewhere in our annual report on Form 10-K for the year ended December 31, 2025, and our 10-Qs and our other reports filed with the SEC. These documents are available on the Investor Relations section of our website at www.senseonics.com. We undertake no obligation to update publicly or revise these forward-looking statements for any reason, except as required by law. Joining me today from Senseonics are Tim Goodnow, President and Chief Executive Officer; Rick Sullivan, Chief Financial Officer; and Brian Hansen, Chief Commercial Officer. And now I'll turn the call over to Tim.
Thanks, Jeremy, and I appreciate everyone joining us today. Looking back over 2025, it's hard to believe how much has changed at Senseonics. This time last year, Eversense 365 had only been available in the United States for a few months, and we were partnered with Ascensia Diabetes Care for all commercialization and sales operations globally. And we were conducting feasibility studies for our Gemini product. On the financial front, our gross margins were hovering around 25%, annual revenue was less than $23 million, and we were in the process of executing a successful cost savings initiative to lower operating expenses. Today, just one year later, Senseonics is a fully integrated developer, manufacturer, and once again, seller of Eversense. We have an exceptional sales and marketing team led by Brian Hansen, our new Chief Commercial Officer, and Eversense 365 is now approved in both the United States and in the European Union.
In 2025, we achieved full-year revenue of over $35 million, growing approximately 60% year-over-year. Our year-long sensor, our continued partnership with health care providers, and our enhanced direct-to-consumer marketing strategy have delivered tangible results with a doubling of patients on Eversense in the U.S., with new patient starts growing 103%, and we have already accomplished margin improvements to greater than 50% to finish the year. 2025 was certainly a year of transformation at Senseonics. The strategic decisions we made last year established a strong foundation for growth in 2026 and beyond. The biggest decision we made in 2025 was to transition all commercial activities from Ascensia Diabetes Care back to Senseonics, removing a layer of complexity from our operations and providing us with a new level of control and agility to execute on our focused strategy. By bringing the sales, customer service, marketing, and sales operations functions in-house, we both eliminate revenue sharing with Ascensia and have the opportunity to respond quickly to meet the needs of people with diabetes.
This change also brings an impressive team of commercial professionals to Senseonics. This end-to-end responsibility for Eversense 365 unlocks operational efficiency, enhances our financial profile, enables more integration between our corporate objectives and commercial results. Additionally, this change simplifies revenue recognition and provides critical insights into the effectiveness of our DTC efforts. PHC remains a meaningful shareholder in Senseonics and will continue to support the European commercialization of Eversense under transition service agreements through the anticipated closing in Europe in the second quarter and establishment of our own in-country operations. To implement this commercial evolution and drive long-term revenue growth, Brian Hansen transitioned to Senseonics and brought with him his complete leadership and sales force team. Brian was formerly the Head of Ascensia's CGM division and prior to that, the Chief Commercial Officer for Tandem, bringing a tremendous amount of experience and expertise from his accomplished career in diabetes care.
In just a few minutes, I'll turn the call over to Brian so that he can give you a firsthand account of what has been a smooth and successful commercial transition. He'll also give his thoughts on our growth trajectory, which he will be instrumental in driving. Excitedly, our integration with Sequel's twiist automated insulin delivery system was another significant milestone in 2025, not just for us, but for the diabetes community at large. Patients utilizing the twiist insulin pump can now use Eversense 365 to send glucose readings seamlessly to their pump for an entire year. This means eliminating a CGM change every 10 to 15 days and providing our type 1 patients with reliable and accurate glucose monitoring 365 days at a time. Our collaboration with Sequel combines the world's most sophisticated glucose sensing, algorithm control and pumping technologies and is just the first of many collaborations we hope to establish with pump partners.
Finally, in 2025, we made improvements in our financials, raised capital from institutional investors and strategic partners, executed a reverse stock split and began trading on the NASDAQ exchange. Similar to our other transformation initiatives, we believe these accomplishments set Senseonics up for long-term growth and disciplined financial execution. Moving on to the leading indicators for 2026, I'll start with a quick reminder that our business is seasonal. The fourth quarter is typically our strongest quarter due to insurance deductibles being met. Further, a higher number of existing customers are available for reorders of Eversense in the quarter because the U.S. commercial launch of Eversense 365 took place in the fourth quarter of 2024. So early adopters translate into annual reorders beginning in this fourth quarter. Through this, we saw meaningful quarter-over-quarter growth for the entirety of 2025, including growth in leads, conversions, new patient starts, and prescribers of our sensor for the first time.
We expect this momentum to continue in 2026, buoyed by our growth initiatives and investments, the twiist integration, and expansion of Eversense into new markets. In January, we received CE marking for Eversense 365, and we expect to launch the global product in Germany, Italy, Spain, and Sweden in the coming months with our own dedicated European sales force. We recognize that patients and providers in Europe have been waiting for us to deliver on our promise of one year, one CGM in their markets, and we now have the approval. We anticipate a similar uptake in interest in new patients on Eversense as we had in the United States. On the product pipeline front, we continue to advance the development of both the Gemini and Freedom products. We expect to complete the Gemini pivotal trials before the end of the year with the launch expected to follow in 2027. Gemini improves on the capabilities of Eversense 365 with an integrated one-year battery and flash glucose monitoring capabilities without a transmitter.
And Freedom is close behind with a launch planned for 2028. I'm confident that our decisions on execution in 2025 will form the foundation of our 2026 growth. We have the right team, the right financial structure, and the world's first and only year-long CGM to improve and simplify the lives of millions of patients worldwide. And with that, I'll now turn the call over to Brian.
Thanks, Tim, and hello to everybody on today's call. I would like to begin by expressing my excitement to be part of Senseonics and my gratitude to the U.S. commercial team that has transitioned to Senseonics from Ascensia. Here in the United States, the move was fairly straightforward, and we were very happy to see nearly 100% of the employees transition with us. We were also able to recognize a few synergies in the move as well as shift several roles around to better align our teams for success in the new year. The same effort is underway in Europe, where I expect the same result, and we have the launch of Eversense 365 right around the corner. More on that later. As Tim mentioned, the strategic decisions taken in 2025 set us up for continued success in 2026 and beyond. Our direct-to-consumer spend was a big growth driver for us in 2025, and we will continue to invest heavily in that channel this year.
It was clear with our revamped DTC campaign and enhanced spend that we could drive significant lead volume and leads drive awareness, patient interest, prescriptions, and ultimately new insertions translating into top-line revenue. There were multiple learnings from our work in 2025. Last year's back-end loaded DTC spend showed there is a sweet spot of investment for us. While we plan to spend a similar amount this year of roughly $12 million to $15 million, we will spend it a little more evenly over the entire year, building into the third and fourth quarters. This should allow us to be more efficient with our resources, targeting higher quality opportunities, a higher close rate, and a lower cost per lead. Another important initiative for 2026 is patient retention. While we are early in the renewals from our first patients on the Eversense 365 sensor, we are happy to report that patient retention is in line with our expectations.
This is and will continue to become a more meaningful part of our business going forward. Programs put in place in 2025, as well as allocating resources to refine and enhance the patient journey with our product and our company, have positioned us nicely for the upcoming year. I would also like to express my gratitude to the legacy employees of Senseonics that have built such an amazing product. Not only does it last a full year as expected, its performance is unsurpassed. We've also been working diligently to support the Sequel twiist, Eversense 365 rollout and expect to see an increase in the type 1 patients we serve as a result. As Tim mentioned, this collaboration enables us to combine two of the world's leading diabetes technologies to simplify life for patients requiring insulin. Anecdotally, I can tell you that from the team being at the Sequel Annual Sales Meeting held earlier this month, we are both aligned and excited.
Sequel has a large commercial presence in the United States, and I can confidently say that both teams have fully bought into this partnership. And now with Eversense 365 compatibility, Sequel is able to offer customers choice in selecting the continuous glucose monitor that works best for them. As a company, we more than doubled the number of Eversense users in the United States from 2024 to 2025. And for this year, our goal is to continue that momentum and double our patient base once again. We believe that we can accomplish this through successful renewal of our existing customers, driving new patient starts in the U.S. and abroad, and having pump integration, which patients have requested for years. Acknowledging we are only a few weeks into the general availability of the combined offering, the results have exceeded my expectations. We have detailed the success of our DTC campaign from last year.
So let's turn to our health care provider channel that continues to grow as well. The number of providers actively prescribing Eversense grew more than 80% year-over-year, reflecting broadening awareness and confidence in the 365-day system. Access to the diabetes centers continues to grow, and we look forward to working closely with the Sequel commercial team to expand our combined reach. We also saw continued expansion of the EON Care Group, our in-house inserter network. We finished the year with approximately 60 providers performing nearly a quarter of all U.S. Eversense insertions. We will continue to add to this team in 2026, planning to end the year with approximately 100 providers driving an even greater percentage of the U.S. procedures. Turning to the European launch and transition for a moment. We are in the final stage of completing our European arrangements with Ascensia, and both companies' teams are collaborating well to smoothly transition the European CGM business.
Our team is working to establish the full organization we need in Europe, and we will utilize transition agreements with Ascensia in countries where we are currently building out our capabilities. Overall, we made great progress with the transition since the announcement in early September. Coming off our national sales meeting to unveil the new Senseonics, the team is energized and off to a good start to the year. This is a testament to our employees' hard work in getting here, their dedication, their belief in the product, as well as the potential future growth ahead of us. I'll now turn the call over to Rick to walk through the numbers.
Thanks, Brian, and thanks to everyone joining us this afternoon. Starting with the quarterly results. In the fourth quarter of 2025, net revenue grew 72% to $14.3 million compared to $8.3 million in the prior year period on the continued strength of top-line Eversense 365 revenue. U.S. revenue for the fourth quarter was $12.1 million, and revenue outside the U.S. was $2.2 million. Importantly, in Q4 of 2025, we continued to recognize revenue through the collaboration agreement with Ascensia. We anticipate recognizing 100% of revenues going forward. We expect a similar channel mix going through our two primary sales channels in the U.S., direct shipments to DME distributors and through bundled payment of the procedure and product, primarily through our consignment program. Outside the U.S., we will sell both through tender agreements and to distributors depending on the region. In Q4 2025, gross profit was $7.7 million, an increase of $3.7 million from the prior year period.
This increase in gross profit was primarily driven by a full year of sales of Eversense 365 with more of our business going through our consignment sales channel where we recognized 100% of the revenue and recorded a sales commission expense to Ascensia based on the current year's revenue sharing percentage. Research and development expenses in Q4 2025 were $8.8 million, a decrease of $0.6 million compared to the prior year period. The decrease was primarily due to the completion of the Eversense 365 system clinical trials and development efforts as well as a reduction in headcount. Fourth quarter 2025 selling, general and administrative expenses were $19.8 million, an increase of $10.9 million compared to $8.9 million in the prior year period, primarily driven by higher selling and marketing personnel costs, promotional expenses mainly due to the DTC investments, sales commission expenses as our consignment program expanded, and other general and administrative costs, including transition costs incurred to support the commercial transition from Ascensia.
Net loss was $20.8 million or a $0.46 loss per share in the fourth quarter of 2025 compared to a net loss of $15.5 million or a $0.40 loss per share in the fourth quarter of 2024. Net loss increased by $5.3 million, primarily due to increased sales commissions and other costs related to taking over the commercialization and distribution of Eversense. For the full year, total revenue was $35.3 million compared to $22.5 million in 2024. U.S. revenue was $27.9 million in 2025 compared to $15.3 million in the prior year, and the revenue outside the U.S. was $7.4 million in 2025 compared to $7.2 million in 2024. Net loss for 2025 was $69.1 million, a decrease of $78.6 million in 2024. The decrease in net loss was primarily driven by improved margins in our business from Eversense 365. Selling, general and administrative expenses for 2025 increased by $18.3 million year-over-year to $52.5 million.
The increase was primarily driven by our direct-to-consumer campaign investments, sales commission expenses as we increased consignment sales and costs related to the Ascensia transition. Research and development expenses for 2025 decreased by $9.5 million from 2024 to $31.6 million. The decrease was primarily due to the completion of the Eversense 365 system clinical trials and development efforts as well as a reduction in headcount. As of December 31, 2025, cash, restricted cash, and cash equivalents totaled $94.3 million, and debt and accrued interest was $35.3 million. We expect full year 2026 global net revenue to be approximately $58 million to $62 million, representing year-over-year growth of 65% to 76% as the company completes the transition of Eversense commercialization from Ascensia and brings the entire sales and marketing infrastructure in-house. Due to the seasonality of our business with deductibles resetting at the beginning of the year and higher utilization of patient assistance programs, we expect to receive the majority of our revenue in the second half of 2026, consistent with what we saw in 2025.
Taking into consideration our margin performance to date, along with the planned launch of Eversense 365 in Europe, which will allow us to be on a single product globally, we expect full year 2026 gross profit margin to be greater than 50% beginning slightly lower and increasing sequentially. We are excited to simplify our business model, the integration of the commercial organization, and will recognize improvements in our top line and the expansion of our gross profit margins. Due to the integration of the commercial organization and supporting transition service agreements from Ascensia, we expect operating expenses to increase by about $70 million, consistent with Ascensia's prior commercial spend. In 2026, we expect total operating expenses to be between $150 million and $160 million with increases primarily in SG&A and a smaller increase in R&D for the Gemini pivotal trial. We expect cash utilization in 2026 to be between $110 million and $120 million, largely as a result of increasing SG&A due to bringing the sales and marketing teams in-house.
Last year, we expanded our debt facility with Hercules Capital up to $100 million, providing access for up to an additional $65 million of non-dilutive capital to help fund our increased operating expenses for the integrated business. With that, I'll turn it back to Tim.
Thank you, Rick. These are exciting times for Eversense with the accelerating growth of our revolutionary 365-day product. We've delivered significant new patient additions and top-line growth across 2025, driven by expanding awareness and adoption of Eversense in the U.S. DTC investments continue to pay dividends as more people become aware of the compelling benefits of our product, and we now have access to a whole new population of patients following the launch of our first AID combination. Our margins are improving and the sales force continues to gain traction with a productive and energized sales force post transition. We are already seeing encouraging retention with many early adopters now on their second year-long sensor, restarting the clock on 365 days of the best-in-class continuous glucose monitoring system. In our exciting pipeline, the disruptive Gemini and Freedom programs are advancing, and we look forward to updating the market on continued progress in due course.
Overall, this was a record-breaking year for Senseonics, but is only just the beginning. Having demonstrated strong commercial progress, we have more confidence than ever in the clinical and commercial potential of Eversense. We also have the control of our destiny following the transition with the right strategy in place and the right people leading the charge. Thank you all for joining us today and for your continued support. We look forward to building on the momentum from the first year of Eversense 365 with another year of growth in 2026. With that, I'll now turn the call over to the operator to answer any questions that you may have. Thanks once again for your time today.
分析師問答
We'll take our first question from Anthony Petrone with Mizuho Group.
Congrats on a strong 2025 execution year. Maybe, Tim, Rick, Brian, I'll start with some of the trends you're seeing here early in the year. You're coming off 2025, with 103% new patient starts for the year, hitting a new high in the fourth quarter. And I know, Rick, there's a little bit of seasonality with policy resets here as you start the year. But anything you can provide just in terms of U.S. new starts at the beginning of the year here? And then I'll have a couple of follow-ups.
Sure, Anthony. Thanks for the question and time. We continue to do very well on new patient starts. The 365 product continues to perform just as we expect. Excitedly, we're now into the more routine cycle of getting the reinsertions. So new patient growth continues as we've expected it to, as we planned it to. January typically is our softest month with the patient resets, but we planned for that. Very encouraging, we've seen a surprising amount of interest with the Sequel product and new patient starts associated with that. So that's very encouraging to see. And we continue to make progress, as you know, with the CE marking for the 365 in Europe. So we're looking for that region to really take off as well here later in '26.
Yes. The follow-up is on that top line guidance, $58 million to $62 million. You have the U.S. clearance here earlier in this year, as well as the twiist product launched February 19. So to what extent in that range do you have some contribution for Europe and twiist? And maybe just a recap on twiist specifically, how the economics are split between Sequel and Senseonics?
Sure. I'll let Rick speak to Europe. From an economic perspective, it's two companies that work together with a focus on marketing and awareness, but the economics are unique to each company. So we sell a sensor, we recognize the associated economics. They sell a pump. And then through the integration that the iCGM enables, the patient enjoys that combination. So there's really no difference economically on a brand-new patient start that's on an MDI versus somebody that's on a Sequel pump.
And then for Europe, over the past couple of years, we've seen fairly consistent revenue in Europe. We're really expecting the growth with the 365-day launch in Q2. And so that, along with the elimination of that revenue share to Ascensia, we do expect Europe to be about 20% of our revenue in 2026.
We'll move next to Josh Jennings with TD Cowen.
It's great to see that you're on track to double new patient starts and your patient base again this year. I just wanted to check in on the takeover of the commercial organization in the United States and from Ascensia. It seems like it has been seamless. All the sales reps converted over to under the Senseonics roof. But has it been as seamless as it sounds? And have there been any friction points?
Yes, Josh, thanks for that. It's a good question. They're really as simple in the U.S. as it sounds; it was as straightforward as we expected. They changed business cards. They got a new computer. They had to do a few things. We even pulled their cars over with them. So quite frankly, it went that simply. And we have a full boat and they all stayed, so we're very fortunate. Outside of the U.S., we have a little bit more work to do as we go through the transition here in the first half of the year, and we're hiring new folks to replace our BGM reps that were supporting both products. Outside the U.S. has a few moving parts differently than the U.S. But so far, the U.S., I mean, we had our kickoff meeting in January, late January in D.C. and everybody was there and excited and focused. And so as I said in my comments, that one has gone very well, knock on wood.
Could you please provide an overview of some of the shortcomings that occurred while Ascensia was leading the commercial efforts? Were there issues with investment in direct-to-consumer marketing? Were they not aggressive enough in seeking out new prescribers? Also, can you discuss how you are addressing any gaps that existed before taking over the commercial operations in the U.S.?
Yes. The strategic execution around the commercial activities really did hand over one-for-one, even in Europe. Where we had some opportunities in the operational part of the organization, for example, there were some quality duplications that happened, some strategy elements that happened. So in those cases, we did do some rationalization. But obviously, since there was just a little bit of upstream marketing around product development that existed in the prior Senseonics organization, that's now been folded into the new Senseonics commercial team. Brian, Rick and Ken, our GC just really did an exemplary job just leading this transition. To be able to get every sales rep, every inside sales rep to go over and be part of Ascensia at 5:00 p.m. on Friday and show up at 8:00 a.m. on Monday as a Senseonics employee was really, really impressive. And absolutely, no knock on wood customer impact through that transition. So it's just been managed and executed with great ability.
That's impressive. And just with the active prescriber base growing 80% last year and with Senseonics now in control of the commercial efforts and the sales team, how do you expect that prescriber base to grow? And then, I mean, just you guys are on track; your guidance when Ascensia was in control, for the commercial effort was to double your patient base in '25 and '26 on the heels of the Eversense 365 launch with control now, complete control. Could you do better than that? Could you see an acceleration in the prescriber base and new patient starts from this doubling, which is an impressive number?
Easy job.
Yes, it seems that Brian is taking on more than just that. In all seriousness, there's a significant push planned for 2025. We have accelerated direct-to-consumer efforts based on the expectation that this focus is truly about raising awareness. By investing in direct-to-consumer marketing, we have reached more patients, who then engaged with their providers, creating greater awareness among providers about Eversense and the excitement surrounding the 365 model. To maintain that level of growth, as Brian mentioned, we are prepared to invest significantly in direct-to-consumer marketing, roughly the same amount as last year, but with a focus on the latter half of the year. The growth ramp corresponds with that investment. We anticipate some slowdown in that ramp as spending normalizes throughout the year, but it will still support our goal of doubling growth, or around 70% revenue growth across the company.
We'll take our next question from Matt Miksic with Barclays.
Congrats on the great progress and results. So maybe some follow-ups. Lastly, on the investment in DTC that has proved to be pretty successful last year. Within the spend this year, how are you thinking about it? Are you front-end loading it, back-end loading it? Is it just become sort of a reliable and important budget item? Just any color you can give us on the size or the direction of DTC spend would be great. And I have a couple of quick follow-ups.
Yes. So, Brian here. We spread it out a little bit more this year. It was, again, as Tim said, more in that last six months, and we really put quite a bit in that September, October, and November time frame. That's when you want to put a bunch in as the fourth quarter is so strong. But we also really stressed our team by doing that. And now to kind of level load it a little bit more, spending not quite half in the first half of the year and then saving a little bit to push into that really important third and fourth quarter is how we're looking at it. And we also learned a lot last year of what works and what doesn't work, what segments we were getting better returns versus others. And so I think we're going to do a much better job this year taking our same spend but maximizing it. And our team is rightsized for that as well right now. So we're expecting to spend the same but get better results as we spread it out across the year, $12 million to $15 million is what we said in our prepared remarks.
Okay. That's helpful. And then I guess the challenges or the sort of friction around getting more implanters up and running, getting more education out there, the DTC is part of that. What do you see as the primary constraints right now in terms of growth, in terms of your ability to address new patient interest and new clinician interest? What are the things you're trying to address to kind of feed things and make the most of the opportunity you have? And then I have just one last question, if that's okay.
Yes. Sure #1, Matt, it continues to be, as I said, it's around awareness. And that's where the DTC really helped that drove it from the consumer level. And then we would certainly augment that with a strong internal team that takes the inbound interest, facilitates, adjudicates, communicates the economics, and frankly, works with the outside sales team, which also plays a very big role in the awareness on the clinical side, on the professionals. So we're going to continue to do that. We have 45 regions right now that are focused in the primary areas, and they are working hard to not only expand their reach but also to go deeper within the clinics. So we think that's an opportunity as well to make sure that instead of one or two doctors in a clinic being heavy prescribers, we're going to turn that into three, four, or five prescribers. So #1 is certainly about awareness. #2, from insertion, you're absolutely right. We're going to continue to focus on it. That said, recall that our Eon program is a major initiative for us, right? We ended the year with about 60 nurse folks that were contracted with us to do the insertions, and we are absolutely on target here as we are now two months into it to end the year at 100 nurses. And we anticipate they'll be doing 30% to 35% of all of our insertions in that time period. So a lot of organic growth through that support initiative as well.
Okay. And then just finally...
We saw a lot of changes in reimbursement last year going from 180 to 365. And certainly, in the first three to four months of the year, we had some things to work through. We've revamped that team. We've seen quite a few good results from that and really getting a clearer picture of reimbursement and making it easier for the physician and the patient to know exactly how this is all going to work. And as Tim said, the insertion and reimbursement piece, we've come a long way over the last 12 months. And so we believe we'll benefit from that here in 2026. We're becoming easier to work with and the volume has certainly helped with that.
And Matt, you'll recall, there was a little bit of a hurdle in early 2025 with the physician fee schedule. They first came out with G codes and then transitioned to the standard CPT codes. Well, we don't have it this year, right? They've republished the results or published the results for 2026. That started right away. So we've been into the economics and implementation of those right from the very beginning of this year.
That's great. Lastly, can you share some insights about the new users signing up, whether they are experienced or newcomers, and where they are coming from? What are some of the key reasons they choose Eversense?
Yes, I'll let Brian discuss the changes we are currently observing with an AID partner. From an investment standpoint, much of our direct-to-consumer strategy and the straightforward nature of the buy and bill process makes this product particularly appealing to Medicare beneficiaries. We have likely shifted to approximately 70% type 2 patients by the end of 2025, though I anticipate this ratio will revert more towards type 1 with our pump partner. We still find that most of our patients are switchers, with around 15% to 20% being new users in the market. Is that about right? Additionally, the rollout of the new pump has been quite promising.
Not much to add to that, Tim. Spot on.
We'll take our next question from Marie Thibault with BTIG.
Nice job on this quarter for sure. I wanted to ask a follow-up here on the EON Care inserter network. You mentioned moving from 60 to 100 this year. What's sort of the gating factor on expanding that more quickly? I know they're doing about 1/4 of volumes. It seems like you could move to 1/3 or better of volume. So I guess what challenges, if any, are there in kind of expanding that network and moving more quickly on that opportunity?
Yes, Marie, there really isn't. It's really about volume and having enough work for them. And there's really no downside to going to 125 or 150 if the volume justifies it. We can keep them busy, and we can identify folks in the areas where we need them. And so that 100 mark seems like a sweet spot, getting an increase in the percentage of insertions that they do is good for everybody, our economics as well as the quality of the work, and it frees up the physicians in the prescriber-only areas where they really don't want to do it. So that's kind of a goal, but it could exceed that. There's nothing that stops us from doing more. We just need to have the volume to keep them busy and justify putting those in places and getting accredited, certified, and trained. But it's a good question. There really is no barrier.
It's great to hear. Following up on the operating spending you mentioned, which is expected to be between $150 million and $160 million this year, I recognize that much of this funding relates to continuing where Ascensia left off. I'm curious about the long-term perspective. Are you anticipating a multiyear investment in this area? Should we expect increases in future years? I want to clarify this now that everything is consolidated under Senseonics.
Yes. Commercial spending will continue to grow alongside our revenue, but it will not increase as significantly as it did in 2026. It will become more efficient. As we launch new products, we will expand into more territories and increase the number of EON Care providers. However, it will decrease as a percentage of revenue going forward. This year, we are initiating a Gemini clinical trial, which adds about $5 million to our R&D expenses. We expect a similar increase next year for the Freedom trial, but R&D expenses should decline in the years that follow.
We'll move next to Jon Block with Stifel.
Tim or Brian, anything around the timing of additional pump partnerships coming on board? Do you expect that in 2026? And then, Rick, does the guidance arguably take into account any thoughts or additional pump partnerships this year?
Thanks, Jon. We do continue to work with additional pump opportunities. We're not yet announcing any of those or going public with them, but we do have quite a bit of interest. Obviously, getting the first one out creates a little bit of a dynamic since there's only one pump company right now that has access to the Eversense, and they've seen an encouraging conversion as a result of that. So we certainly expect that's going to work in our favor. But we have not, as of yet, modeled additional pump companies in. We would look for that to be upside, but still not announcing timing on the next one yet.
Okay. And then I'll just try to get a little bit more granular on the revenue. Rick, you provided some details on the cadence. It was more, I believe, what you alluded to, call it, like 2H '26 versus 1H. But any more details you can give, just even, call it, 1Q due to some of the moving parts with Ascensia? When I look at straight around $10 million and those moving parts and here we are in early March. Is that sort of a good figure to, call it, set ourselves and then think about the other commentary you provided 2H versus 1H?
Yes. From a revenue perspective, we know that we have a seasonality in Q1 with the deductibles resetting and higher utilization of our patient assistance programs, which impacts that ASP through that channel. And then also the second half of the year is typically where we have some large renewals from the past couple of years with the 365 launch. The revenue is certainly back-half loaded, and I do expect it to be similar to 2025, thinking about 40% in the first half, 60% in the second half, approximately. And we will see certainly a step down in Q1 because of that seasonality from where we were in Q4.
We'll move next to Ben Haynor with Lake Street Capital Markets.
First off for me, regarding the DTC marketing, what kind of lessons are you discovering? For example, in areas with more users, do you notice a greater impact from advertising? Does increased awareness in a particular area lead to lower user acquisition costs? How should we approach understanding some of the dynamics of DTC marketing?
Yes, we could talk about that for hours. The first and foremost is we tend to really focus where we have qualified inserters. And so we've played with that geography boundary. We can geofence our spend. It's very interesting when you start moving it 75, 100, 125 miles, how you start to reduce the effectiveness of it when you get too far away from an inserter. So to Marie's question earlier of getting more insertion areas and coverage really helps us then maximize our DTC efforts going forward. Then you get into the different channels, you get into the different markets that you try to pour a little bit more into and it typically success breeds success there. And so we watch that very closely when we see areas that we get a better return, lower cost per workable lead, all the things that we follow very well. We continue to pour more in until we see it diminish at that point. And then we certainly test a whole bunch of different ads and methods that we go through.
The team is constantly changing those almost on a week or two-week basis in different markets at times as well. So sophistication is very, very interesting. And what we found last year is we did fairly well, especially with the robust Medicare reimbursement we had, we really started to lean into some of those areas and again, where we had proper coverage for insertion. So I can go on and on to the different levers that we pull, but you really do start to lean into those areas you're doing very well and continue to invest more and more in those until you see it start to slow down a little bit. And that's some of the learnings we really got from last year and will continue this year, but I think we've got a more focused effort as we go into '26.
Great. That's helpful color. And then are you seeing any changes to the behavior of new prescribers with the 365-day version?
No, I wouldn't say there's been a change in behavior. Certainly, interest level, the recognition and now the feedback, it's much more common to see feedback from users now that have gone on to their second sensor. The retention rates are encouraging, right? People love the product. When they use it for as long as a year, it becomes part of their life, right? So I would say from that perspective, a convert is very, very attractive to us. But from a new patient perspective, I don't think we see any real behavior differences from what we've seen before nor from the prescriber side.
Okay. Got it. And then on that retention comment, can you remind us kind of where the expectations are for retention and that are being exceeded?
Yes. We haven't updated those as yet as we're still honestly pretty early into the one-year renewal cycle. But our history had been from first to second sensor, it was in the 70s. Second to third sensor was in the 80%. And then by the time people were on the third sensor, it was 90% retention or sometimes even higher as is evidenced in our European markets. So I would anticipate that the largest drop-off is from first to second, but still some pretty attractive rates.
We'll take our next question from Sean Lee with H.C. Wainwright.
I just have two of them. So first, for the European market, what's the expected timeline for the rollout there? Are you seeing any hurdles from the transition, especially as I know some of these are affected by local purchase agreements?
Yes. The timing is consistent as we've guided since the beginning of the year, that being; we expect the transition to occur in the second quarter. That is gated by the transitions that we're going through right now. Many of these markets are tender markets, so they're contracted with Ascensia, and we are transitioning those to Senseonics. We're in that process right now. We did receive the approval of the CE Mark. So we have the authorization to go. And we'd anticipate mid-second quarter that we'll be rolling out the product into those markets. Some of the tenders will go through the summer, even into early fall depending on the contracts that we have. But say, May through September, October time period, we'll transition.
Great. My second question is on the Gemini study and how the potential approval would go for that. I was wondering, is the FDA requiring a second MARD for the flash mode for the Gemini because it has both 2 different functionalities versus Eversense 365? How does the inclusion of the dual modality impact the complexity of the trial?
Yes, the FDA will expect that in the flash mode or in the near-field mode with the transmitter, it will give you the same result. So the expectation is it's the same chemistry, the same sensor. Our expectation and their expectation should be that it's iCGM compliant. And as you recall, our MARD is around 8% that supports that, and we don't have any reason to expect that that would change. But technologically, there should be no reason why you get a different result in flash or with near field.
Thank you. This does conclude our question-and-answer session and today's conference. You may now disconnect your lines. Thank you for your time, and have a great day.