Penumbra Inc Q4 FY2023 earnings call

• Total revenues for Q4 2023 were $284.7M, up 28.7% year-over-year. Full year 2023 revenues were $1,058.5M, up 25% year-over-year.
• Global thrombectomy had record revenue in Q4 2023. U.S. thrombectomy grew 46.4% in Q4 2023.
• Gross margin in Q4 2023 was 65.7%, expected to expand in 2024.
• Focus on innovation, internal readiness, and market access to expand thrombectomy reach.
• Non-GAAP operating income in Q4 2023 was $37.4M, adjusted EBITDA was $53.4M.

For the fourth quarter of 2023, global thrombectomy revenue was $190.8 million, an increase of 42.4% reported and 41.6% in constant currency year-over-year. Global embolization and access revenue was $93.9 million, an increase of 7.6% reported and 6.7% in constant currency year-over-year. For the full year 2023, global thrombectomy revenue was $677.3 million, an increase of 32.5% reported and 32.3% in constant currency. Global embolization and access revenue was $381.2 million, an increase of 13.4% reported and 13.2% in constant currency.

• 2024 total revenue guidance: $1,230M to $1,270M (16-20% growth year-over-year).
• U.S. thrombectomy expected to grow 27-30% in 2024. U.S. business expected to grow 22-25% in 2024.
• International thrombectomy to grow modestly in 2024, with acceleration expected in 2025.
• Focus on regulatory, reimbursement, and market access for CAVT products outside the U.S.

• Payer scrutiny on mechanical thrombectomy.
• Distributor ordering patterns affecting international revenue, especially with anticipation of new CAVT products.
• Certain international markets with unprofitable embolization and access products where reimbursement pricing doesn't match product value.

Q: What's the impact of payer scrutiny on mechanical thrombectomy?

A: Adam Elsesser stated they haven't seen the type of scrutiny mentioned, with some areas like hospital outpatient use showing increases.

Q: How is the sales cadence for 2024?

A: Jason Mills mentioned cadence is based on distributor order timing and product launches, with good visibility.

Q: Any update on Thunderbolt trial?

A: Adam Elsesser said the trial is going well but Thunderbolt revenue isn't counted in 2024/2025 projections.

Q: Status of VAC processes for Flash or Bolt?

A: Adam Elsesser said a lot of administrative work is done, moving to physicians using the product regularly.

Q: Update on international markets and product exit?

A: Adam Elsesser said certain international markets have unprofitable embolization/access products, focusing on profitability while preparing for CAVT growth in international markets