ResMed Q3 2025 Earnings Call Transcript

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Provided by Quartr
April 23, 2025
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Operator

Greetings, and welcome to the Q3 Fiscal Year twenty twenty five ResMed Earnings Conference Call. My name is Kevin, and I'll be your operator for today's call. At this time, all participants are in a listen only mode. And also please note this conference call is being recorded. Later, we'll conduct a question and answer session.

Operator

Let me hand the call over to ResMed's Chairman and CEO, Mick Farrell, for a brief introduction of Sally Schwartz, who recently joined the company as Chief Investor Relations Officer. Mick, please go ahead.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Thank you, Kevin. I'm very excited to have Sally join the ResMed team, our newest ResMedian. She joined us earlier this week and brings more than two decades of experience across capital markets, healthcare and technology. We look forward to Sally helping us to take Investor Relations to the next level here at ResMed, providing clarity, transparency and long term alignment amongst current and future investors and all of our stakeholders. So Sally, we're thrilled to have you on board.

Salli Schwartz
Salli Schwartz
Chief Investor Relations Officer at ResMed

Thanks, Mick. I'm happy to be here and I look forward to meeting our investors very soon. But first, I want to welcome our listeners to ResMed's third quarter fiscal year twenty twenty five earnings call. We are live webcasting this call and the replay will be available on the Investor Relations section of our corporate website later today. Our earnings press release and presentation are both available online now.

Salli Schwartz
Salli Schwartz
Chief Investor Relations Officer at ResMed

During today's call, we will discuss several non GAAP 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. We encourage you to review the supporting schedules in today's earnings press release to reconcile these non GAAP measures with the GAAP reported numbers. In addition, our discussion today will include forward looking statements, including, but not limited to, expectations about our future financial and operating performance. We make these statements based on reasonable assumptions.

Salli Schwartz
Salli Schwartz
Chief Investor Relations Officer at ResMed

However, our actual results could differ. Please review our SEC filings for a complete discussion of the risk factors that could cause our actual results to differ materially from any forward looking statements made today. I'll now turn the call over to Mick.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Thank you, Sally, and good morning, good afternoon and good evening to folks from Asia here in North America and those in Europe as we welcome our shareholders around the world and review results for our third quarter of fiscal year twenty twenty five. I'm excited to report that ResMed delivered another strong quarter, achieving excellent top line and bottom line results. We delivered solid revenue growth, gross margin expansion both sequentially and year on year, very strong free cash flow generation and maintained our disciplined approach to investments in both research and development and SG and A. This performance reflects broad based momentum and disciplined execution to capture growing demand for our products. Our continued success is driven by our market leading value proposition with top quality hardware and top quality software products as well as our expansive digital health software ecosystem.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

With cloud connected devices, digital health platforms and investments in machine learning, artificial intelligence as well as generative AI technology, our results are a testament to the work that we do to enhance sleep health, breathing health and health care delivery in the home. Thanks to the over 10,000 ResMedians who make that happen by delivering products and services to serve patients in over 140 countries worldwide. As the global leader in helping patients with chronic respiratory conditions, we are closely monitoring the evolving global trade environment, particularly in the area of tariffs. In my current role as a Board member at AdvaMed and the current Chair of the International Committee on the AdvaMed Board, we will continue to urge countries around the world to exempt all medical devices from tariffs on a humanitarian basis. For us here at ResMed, the news is even better.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

I can report that because of the fact that our products are used to treat patients with chronic respiratory conditions that have been subject to global tariff relief for decades. We have reaffirmed that, that is the case with federal authorities just this month in the current setting. In short, ResMed is very well positioned with exemptions in place for our products that are used to treat sleep apnea and respiratory insufficiency as well as other chronic respiratory conditions. In terms of ResMed's inherent strengths of outperforming our competitors with prior externalities such as the COVID crisis, the supply chain crisis and our ability to ramp up to meet the needs when our competitors simply could not, I will say this: our exceptionally strong balance sheet and our net cash position, our global scale, our accelerating operational efficiency as well as ongoing cost discipline gives us the confidence to not just survive, but to thrive, whatever the market may bring. ResMed is all about stability and balance in times like this.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Ultimately, we're committed to make sure that sleep therapy, breathing therapy and health care technology that's delivered in the home is both accessible and affordable as well as ensuring that the delivery of our solutions is consistently available for our patients, for our providers and all of the health care partners in our global ecosystem. Our Sydney based and Singapore based facilities continue to be the core of our manufacturing leadership globally. In addition to that, we will soon open our newest manufacturing location in Calabasas, California. This will double the size of our current manufacturing footprint in The United States Of America, serving as the hub of our research and development for our motor technology, increasing the manufacturing capacity of core motor technology even closer to our largest market here in The U. S.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And expanding manufacturing of silicone mask cushions, leveraging advanced molding technology that ResMed leads the world in. This facility is designed to scale over the coming years with multiple mask molding cells and more growth as mask manufacturing increases to meet growing U. S. And global demand. And I can tell you, these factories are very automated and very high-tech.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We're getting in we're also investing in getting to our products to our home care providers even more efficiently here in The United States. Our largest distribution facility worldwide is our five and twenty two thousand square foot campus in Atlanta, Georgia. We also have a West Coast facility just up the road from us here up in Moreno Valley, California. Over half of our global research and development investment is now U. S.-based, with tenfold growth in American R and D over this last decade.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

These investments reflect our leadership, our economic development focus and the health care impact that we have as ResMed right here in The U. S, where we have our global headquarters and where we support our largest global market, The U. S. Domestic market. ResMed is an innovation machine, and our ongoing investments of over 6% to 7% of revenues into research and development is a key growth driver of our long term success.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

I'm proud that we have been recognized for these market leading efforts as we were named in the LexisNexis list of the top 100 global innovators. This award is given to market leading companies that are driving pioneering innovation the global economy. We continued to introduce new technology to our customers in the third quarter, because it's nice to get awards, but as my father, the founder of ResMed says, innovation is when customers actually pay for it. This quarter marked the first full commercial rollout of Nite Owl in The United States. Nite Owl is a fingertip sized home sleep apnea test that is being used by physicians, sleep labs as well as independent diagnostic and testing facilities, known as IDTFs, to diagnose patients.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Widespread adoption of our Nite Owl product will help more efficiently move patients through the screening and diagnostic funnel so that physicians can then write prescriptions and home care providers can then set up those patients on therapy and take care of them for life. In addition to the nationwide launch of Nite Owl, we're providing our sleep lab partners with even more new technology this quarter. On April 15, we launched the AirSense 11 version of VpAP TX. VpAP TX is our sleep lab testing and titration platform built specifically for both hospital as well as outpatient sleep lab environments. VpAP TX is purpose built to support everything that a sleep physician needs in the sleep lab, including titration, evaluation and setup across every therapy mode that ResMed offers, including CPAP, APAP, BiLevel S, BiLevel ST as well as adaptive servo ventilation, also known as ASV therapy.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

VpAP Tx gives physicians gives RPSG techs and respiratory therapists a powerful new tool to personalize the gold standard positive airway pressure treatment decisions, and ultimately to accelerate adoption of long term therapy for their patients through personalization of that therapy. The VpAP Tx platform is built for flexibility, for precision and for clinical confidence. When we pair NideOwl and VpAP Tx with AirView, our cloud based software for physicians and home care providers, they become part of a complete connected pathway from diagnosis and titration to prescription and ultimately therapy adherence. Of course, we are working to incorporate diagnostic insights from Nite Owl into our MyAir patient app and to incorporate diagnostic data from both Nite Owl and vPAP Tx into Somnware. SomnAware, our software for physicians and sleep physicians' practices, continues to grow in its reach and has been adopted by one of the largest private health care systems in The United States as well as being further expanded within the U.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

S. Veterans Administration, or VA. Our investments in testing devices and diagnostic tracking software, which benefits potential patients, sleep labs and our home care providers, demonstrate ResMed's depth of commitment to the entire sleep health and breathing health ecosystems that provides access to the market leading sleep apnea therapy, and that's from ResMed. We will continue to invest in our digital health ecosystem to help expand the diagnostic funnel to keep up with expanding new patient flow from both our own demand generation, demand capture investments as well as capturing demand from two powerful macro trends: one, the widespread adoption of GLP-one medications, both in The U. S.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And worldwide and two, accelerating momentum in consumer wearables. For consumers coming into the funnel from all of these areas, ResMed will be known as the company answering their questions about sleep health. I call this concept a digital sleep health concierge capability, including screening protocols, clinical tools, seamless workflows and cloud connected care pathways. ResMed is the leading global brand in the field of sleep health and breathing health. We want to expand the reach of that brand to help the more than two point three billion people that need our help for their sleep apnea, or as I call it, sleep suffocation, their insomnia, inability to get to sleep, stay asleep or their respiratory insufficiency due to chronic obstructive pulmonary disease or neuromuscular disease.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

During the quarter, we announced a comprehensive ResMed brand evolution strategy designed to unify our global brand portfolio into one across sleep health, breathing health and health care technology that is delivered into the home. We will continue to build ResMed brand awareness and evolve our brand to be closer to each and every customer. However, I want to make it clear that our marketing team will make certain that there is a positive return on investment, or ROI, for every single demand generation, demand capture and demand conversion project that we launch. As we move more and more people into the diagnostics and treatment funnel. When we talk about ResMed brand development, please note that internally, that means ResMed brand ROI as well.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

An example of our disciplined demand generation experimentation is shown in our latest effort to educate physicians. We have launched a targeted demand generation program through continual medical education, also called CME programs, to help teach physicians the benefits of CPAP, APAP and bilevel therapies for their patients. These targeted education efforts are having an impact with measurably increased prescriptions from those physicians. In addition to physician education, we're also reaching out to consumers, looking for what we call sleep health concerned consumers. On this front, I'm happy to say that our experiments on streaming advertising in select cities have resulted in significant increases in patient flow into the screening and diagnostic funnel.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

It remains early days with these first cities, but we are seeing an openness in consumers to messaging that helps them find relief from their sleep apnea or sleep suffocation and their lack of good quality of sleep that could be insomnia. We're also continuing to build long term value across our existing patient base to keep patients on therapy for their own personal health and for the good of the whole health care ecosystem. Research shows that patients who are enrolled in a compliant, world class resupply program are more likely to stay adherent to our therapy over the long term, and therefore, to have better health outcomes. With the provision of just one additional item per patient per year achieved by more efficient outreach, we believe we can provide exceptional value to our home care provider customers and make sure that our patients have access to new clean masks and accessories for better care and better outcomes for them and for their physicians. Our focus is on driving increased patient adherence, improving outcomes.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Programs like Brightree Connect, Resupply Complete and Resupply Essentials that are available for HME customers on any of their EHRs and ERPs they may use, combined with personalized engagement through MyAir, are delivering strong results with home care providers right here in The United States. We have the opportunity to adapt and scale these types of resupply and adherence technologies globally to the 140 countries ultimately that ResMed is able to deliver care in. Keeping patients on therapy is our moral imperative, our obligation here at ResMed, and it's firmly supported by scientific research. During the quarter, The Lancet Respiratory Medicine Medical Journal published a landmark meta analysis. And a meta analysis has a higher clinical value than a randomized controlled trial, or RCT, that many people have considered and looked at as the gold standard for clinical trials.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So in short, The Lancet publication showed that CPAP therapy reduces all cause mortality by thirty seven percent. It reduces overall death rates by thirty seven percent. And further, that study went on to say that CPAP therapy reduces cardiovascular mortality by fifty five percent. So CPAP reduces cardiovascular death rates by fifty five percent. And this study wasn't small.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

This meta analysis included over 1,000,000 participants. So here at ResMed, we've known for decades that CPAP improves quality of life for sleep apnea patients. We've talked internally about these improvements in cardiovascular and mortality health. But now we have proof that it helps people to ultimately live longer and to live better. These data show that CPAP is not just another medical therapy.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

It's literally a case of life and death. So here at ResMed, we make the smallest, quietest, most comfortable, most cloud connected and most intelligent therapies for sleep apnea, insomnia and respiratory insufficiency. We also have the market leading software for health care technology that is delivered right where people want to be, which is in their own home, with home medical equipment, home health, home nursing and software that's beyond. To our shareholders around the world, we are building on our ResMed foundation with our long term leadership in our global markets. We now serve approximately 151,000,000 lives through our hardware and software platforms.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And we remain on track toward our ambitious goal of improving 500,000,000 people's lives in 2,030, zero point five billion worldwide. This quarter's results show the strength of our strategy, our investment in R and D, the clarity of our execution and the scale of our impact. We launched a renewed and refreshed brand. We scaled digital diagnostics and titration tools. We expanded intelligent therapy.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We activated new patients. And really importantly, we replenished supplies for existing patients worldwide. And while doing all of this, we also delivered very strong financial results with top line growth and leverage down to the bottom line. I'd

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

say

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

this, we're just getting started. So thank you to every one of the 10,000 ResMedians around the world who made that possible and will make it possible our future growth. And with that, I'll now hand the call over to Brett, who's in Sydney today, for a deeper dive into our financials. And then we'll open the floor up for questions. Brett, over to you.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Great. Thanks, Mick. In my remarks today, I will provide an overview of our results for the third quarter of fiscal year twenty twenty five. Unless noted, all comparisons out of the prior year quarter and in constant currency terms were applicable. We had strong financial performance in Q3.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Group revenue for the March was $1,290,000,000 an 8% headline increase and 9% in constant currency terms. Revenue growth reflects positive contributions across our product and resupply portfolio. Year over year movements in foreign currencies negatively impacted revenue by approximately $13,000,000 during the March. Looking at our geographic revenue distribution and excluding revenue from our residential care software business, sales in U. S, Canada and Latin America increased by 9%.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Sales in Europe, Asia and other regions increased by 8% on a constant currency basis. Globally on a constant currency basis, device sales increased by 7%, while masks and other sales increased by 12%. Breaking it down by regional areas, device sales in The U. S, Canada and Latin America increased by 6%. Masks and other sales increased by 13% reflecting continued growth in resupply and new patient setups.

Brett Sandercock
Brett Sandercock
CFO at ResMed

In Europe, Asia and other regions, device sales increased by 9% on a constant currency basis, while masks and other sales increased by 7% on a constant currency basis. Residential Care software revenue increased by 10% on a constant currency basis in the March underpinned by strong performance from our Medifox DAN software vertical. During the rest of my commentary today, I will be referring to non GAAP numbers. We have provided a full reconciliation of the non GAAP to GAAP numbers in our third quarter earnings press release. Gross margin increased by 140 basis points to 59.9% in the March.

Brett Sandercock
Brett Sandercock
CFO at ResMed

The year over year increase was primarily driven by manufacturing and logistics efficiencies as well as favorable shifts in product mix partially offset by unfavorable foreign currency movements. Sequential gross margin increased by 70 basis points primarily driven by manufacturing and logistics efficiencies. We continue to make good progress on our gross margin expansion initiatives and we are focused on making sustained long term gross margin improvements. Looking forward and subject to currency movements, we expect our gross margin in Q4 FY twenty twenty five to be broadly consistent with our third quarter gross margin. Moving on to operating expenses.

Brett Sandercock
Brett Sandercock
CFO at ResMed

SG and A expenses for the third quarter increased by 7% on a headline basis and by 8% on a constant currency basis. The increase was predominantly due to increases in employee related expenses and increases in marketing expenses including costs associated with our recent global brand launch and demand generation activities. SG and A expenses as a percentage of revenue improved to 19% compared to 19.2% in the prior year period. Looking forward and subject to currency movements, we expect SG and A expenses as a percentage of revenue to be in the range of 18% to 20% for the remainder of fiscal year twenty twenty five. R and D expenses for the quarter increased by 9% on a headline basis and by 11% on a constant currency basis.

Brett Sandercock
Brett Sandercock
CFO at ResMed

The increase was predominantly attributable to increases in employee related expenses. R and D expenses as a percentage of revenue was 6.5% compared to 6.4% in the prior year period. Looking forward and subject to currency movements, we expect R and D expenses as a percentage of revenue to be in the range of 6% to 7% for the remainder of fiscal year twenty twenty five. Operating profit for the quarter increased by 13% underpinned by revenue growth and gross margin expansion. Our net interest income for the quarter was $1,000,000 Our effective tax rate for the March was 20.1% compared to 20.3% in the prior year quarter.

Brett Sandercock
Brett Sandercock
CFO at ResMed

We estimate our effective tax rate for the full fiscal year 2025 will be in the range of 19% to 21%. Our GAAP effective tax rate for the March was 12.6% as we recorded a net income tax benefit of $30,000,000 relating to interest on our tax refunds from the IRS. We have treated this tax benefit as a non GAAP item in our third quarter financial results. Our net income for the March increased by 11%. The non GAAP diluted earnings per share of $2.37 also increased by 11%.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Excluding the impact of investment portfolio write downs in Q3 totaling $6,000,000 earnings per share for the March was 2.41 an increase of 13% over the prior year period. I would like to comment on the expected impact of U. S. Tariffs, particularly associated with the introduction of a 10% tariff on exports to The U. S.

Brett Sandercock
Brett Sandercock
CFO at ResMed

From Australia and Singapore. These locations are where we currently manufacture most of our devices and masks for The U. S. Market. We have for many years been importing our products under a chapter of the harmonized tariff schedule of The United States that governs the importation of certain medical devices including equipment to to treat sleep apnea and other chronic respiratory conditions.

Brett Sandercock
Brett Sandercock
CFO at ResMed

We've worked hard over the years to achieve that status and to maintain it for products we sell in The United States. As a result, we have historically paid negligible duties or tariffs on the importation of most of our products. On April 5, U. S. Customs and Border Protection issued a notice of implementation confirming that current tariff treatment of our products like ours continues.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Accordingly, we do not expect the introduction of U. S. Tariffs to have a material impact on our financial results. We also continue to improve the resilience of our global supply chain by expanding our manufacturing footprint in The U. S.

Brett Sandercock
Brett Sandercock
CFO at ResMed

We expect to open our $30,000,000 advanced manufacturing facility in Calabasas, California in June 2025. This high-tech facility will almost double our manufacturing footprint compared to the existing footprint in our Chatsworth, California facility. Over time, it will significantly expand our production capacity in mask resupply for The United States. Cash flow from operations for the quarter was $579,000,000 This does include a refund of tax and interest from the IRS of $107,000,000 Excluding the impact of the tax refund, our operating cash flow was $472,000,000 for the quarter, reflecting strong operating results and lower working capital. Capital expenditures for the quarter was $21,000,000 Depreciation and amortization for the quarter totaled $44,000,000 We ended the third quarter with a cash balance of $933,000,000 On March 31, we had $675,000,000 in gross debt and $258,000,000 in net cash and we have $1,500,000,000 available for drawdown under our revolver facility.

Brett Sandercock
Brett Sandercock
CFO at ResMed

We continue to maintain a solid liquidity position and with robust operating cash flows and a strong balance sheet, we are well positioned to weather the current global uncertainty and respond to geopolitical challenges. Today, our Board of Directors declared a quarterly dividend of $0.53 per share. During the March, we purchased approximately 314,000 shares under our previously authorized share buyback program for consideration of 75,000,000 We plan to increase our ongoing share buyback program and purchase shares to the value of approximately $100,000,000 per quarter commencing in Q4 FY twenty twenty five. This will comfortably more than offset any dilution from the vesting of equity to employees during the year. Going forward, we plan to continue to reinvest in growth through R and D, deploy further capital for tuck in acquisitions and continue our share buyback program.

Brett Sandercock
Brett Sandercock
CFO at ResMed

And with that, I will hand the call back to Sally.

Salli Schwartz
Salli Schwartz
Chief Investor Relations Officer at ResMed

Thank you. We will now begin the question and answer session. I'll turn the call over to our operator Kevin to provide instructions.

Operator

Thank you.

Operator

Our first question is coming from Leanne Harrison from Bank of America. Your line is now live.

Lyanne Harrison
Lyanne Harrison
Analyst at Bank of America

Good morning, Nick, Brett and welcome, Sally. Can I start with gross margin? Obviously, very strong gross margin expansion there. Can you talk us through in terms of each of the factors that attributed to the expansion? How much of it was driven by each?

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

I'll let start off on that.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Yes.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Look, it's of said in the prepared remarks, the big driver was manufacturing distribution efficiencies. So if we look through that and these were all meaningful contributions. It's not just one factor. So we had, if you like, manufacturing efficiencies or better recoveries through the factories. Distribution and freight, we're seeing improvements there coming through.

Brett Sandercock
Brett Sandercock
CFO at ResMed

The AS10 to AS11 transition of that platform continues and we see some benefit with that as well. And then component costs as well are actually starting to contribute to that gross margin expansion as well. So those factors were all meaningful in terms of manufacturing and distribution efficiencies. And the other one was product mix year on year as well with that the mask growth relative to device growth. We saw some favorable or positive product mix as well.

Brett Sandercock
Brett Sandercock
CFO at ResMed

And they were those were the key drivers of the margin expansion.

Operator

Thank you. Our next question today is coming from Margaret Kaczor from William Blair. Your line is now live.

Margaret Kaczor Andrew
Research Analyst - Healthcare at William Blair

Hey, good afternoon. Good morning, everyone. Sally, good to meet over the phone. Maybe a bigger picture question for a second. Certainly, on the short term, we've heard that sleep labs are facing backlog of patients.

Margaret Kaczor Andrew
Research Analyst - Healthcare at William Blair

So it would be curious if that's gotten better or worse. But as we connect that concept with a series of investments, Mick, that you talked about pre and post diagnosis of sleep apnea, I'm curious what metrics you guys are tracking for these investments and when they should start to show up in results more meaningfully? I'm just trying to compare it to other growth factors that you guys did do, for example, resupply services that you provided in the past. Is this better, worse, slower, faster, anything that you could provide? Thanks.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Yes, Margaret, it's a great question and allows us to talk pretty broadly about demand generation, demand capture, demand curation and ultimately getting more of the over one billion people worldwide who suffer from obstructive sleep apnea on to therapy, sleep suffocation on to therapy. Yes, as you mentioned, as I discussed in the prepared remarks, the launch of Nite Owl, a fingertip sized home sleep apnea test should inspire the market. And I encourage the other players in diagnostics to make smaller and more dynamic and capable because the Sleep Lab backlogs are at all time highs. We track the metrics of how long a patient waits from a referral to a diagnostic, and we've got really detailed metrics on that for both in lab and home sleep apnea testing. I can say this, that during that COVID emergency, everyone embraced telehealth, everyone embraced digital health, and we saw almost every sleep lab around the world embrace home sleep apnea testing as well.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So we think that combination of us bringing Nite Owl and making it available to everyone, sleep labs, IDTFs, primary care physicians across the board, and empowering the sleep labs to take care of the toughest patients, the patients with overlap syndrome, where you have gotten right obstructive sleep apnea plus chronic obstructive pulmonary disease. You have diseased lungs and an obstructed upper airway. And the gold standard therapy for that is a bilevel S or ST or even STA. And if you don't have the right titration equipment, you may not be able to get the patients through. If you have too many gut variety, I would say, patients clogging up the beds, you don't get access to them.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So that combination of NideOwl for those who screen for likelihood of garden variety obstructive sleep apnea and then making sure the sleep lab beds have VpAP TXs in them, so they can get a CPAP, an APAP, a bilevel, STSTA, or if they have complex sleep apnea, an adaptive server ventilator, such as our market leading ASV. And so yes, it's that combination. So what metrics are we tracking, Margaret? We're tracking that time to titration, time to test, TTT. We're also tracking time from that titration or test through to therapy onset.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And what if there's any churn, what is the churn in terms of patients dropping out from referral to diagnostic and from diagnostic to therapy and then from therapy setup to first thirty days, first ninety days, first one year and then for life. Because as you know, we don't have a cure here. We have a treatment for life. And ResMed's goal is laser focused on that, overlapping, if you like, altruism of the patient has a better outcome, lower chance of death, as we talked about through that landmark study in Lancet. And our ecosystem does well because obviously, HMEs and ResMed are able to overlap that altruism with some profit motive and be able to have that resupply be profitable for the channel that allows us to then have revenue to reinvest into R and D, which we do at 6%, seven % of the revenue that we have.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So great question, Margaret. It's a complex one. We're tracking many metrics there. The ones we'll go public with are probably around the lines of, are we seeing a bend in that curve? Are we having less of a backlog?

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Are we getting more patients into the lab? And are we seeing an expansion of home sleep apnea testing from both pharma referrals and GLP-one consumer tech as well as ResMed's own consumer demand generation? So we'll continue to update you as we go forward here. It's a marathon, not a sprint.

Operator

Thank you. Next question is coming from Talai Natan from Goldman Sachs. Your line is now live.

Davinthra Thillainathan
Davinthra Thillainathan
Healthcare Equity Analyst at Goldman Sachs

Hi, Nick and team. Just I guess a question on your share buybacks. You've increased the amount of debt to $100,000,000 and you've done about $75,000,000 the quarter just past. Could you talk to the confidence in doing that in light of the demand environment you're seeing, just given some uncertainty now with tariffs as an example? And then also just related to that, the thought about capital allocation between buybacks and M and A, given the valuation sort of recess we've seen in the public markets?

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So I'll go first and then I'll hand over to Brett. Actually, Brett, why don't you go first on the increase in the share buyback, because going from $300,000,000 a year to $400,000,000 a year, I think is good step up. There's obviously no artificial limit. Our Board, my fellow Board of Directors and I are very supportive, where it's accretive, to give cash back to shareholders. You've seen that in our long running dividend program.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

It's been upped And share buybacks are an efficient way to give cash back to shareholders. We've shown that in the past and where it's accretive to us, I think we'll continue to do that. You saw that in Brett's prepared remarks. So Brett, why don't you address that first and then I'll talk a little bit about other uses for capital, particularly around M and A tuck ins and things like that.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Sure. Thanks, Mick. Yes. And then, I guess, we're looking to balance that. It will be around dividends.

Brett Sandercock
Brett Sandercock
CFO at ResMed

It will be buyback. It will be the tuck in acquisitions and Mick will talk about that in a little while. So we want to get that balance right. But at the moment how we see it is we've got very strong operating cash flows and a very robust business. We have we're net cash position on the balance sheet, so we've got an exceptionally strong balance sheet as well.

Brett Sandercock
Brett Sandercock
CFO at ResMed

So the Board and management feel very confident of up ticking that buyback from $75,000,000 to 100,000,000 a quarter that it is accretive buyback. And I think overall, I feel that that sort of gets the balance right in terms of capital allocation buying back the stock there. So we've upticked that and we feel confident to do that.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Yes. And I'll just fully in line with Brett there, use of capital, dividends, share buyback, actually the best investment is investing back in the business, which we do, 6% to 7% back into R and D and 'nineteen to 20% there in SG and A. But look, the money is not burning a hole in our pocket. Obviously, we generated incredible free cash flow, dollars $558,000,000 for the quarter, 1,600,000,000.0 of free cash flow in the trailing twelve months. But we do look at M and A as an interesting area to accelerate our growth towards our 02/1930 strategy.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So as we look at M and A, we're looking at tuck ins sort of sub-ten percent, sub-five percent even of our market cap, sub 1%, I'd call it, definite tuck in. There are a number on our radar screen. Nothing to announce here on this earnings call. It may not be too far before we announce something. Are actively out there.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

But I'll say this, the acquisitions that we look at have to meet three criteria. Number one, they're in line with our 02/1930 strategy. They're going to help us be the world leader in sleep health, breathing health and health care technology delivered at home. Two, the financials have to be there. That's to be an ROI, it has to get the ROIC to the WACC at an appropriate period of time.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We have to have free cash flow. We have to be the best owner of that asset. We have to be a better owner of the asset than the current owners in terms of expanding it globally, expanding it around The U. S. And expanding it to all the 100 countries we're in.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And thirdly, it's going be a cultural fit. It's going to be aligned with ResMed's ethics, integrity, doing the right thing when no one's watching and beyond. So watch this space. Nothing to report, but I'm really excited to be upping the share buyback and watch this space for the tuck in M and A over the coming six, twelve months.

Operator

Thank you. Next question is coming from Anthony Petrone from Mizuho Group. Your line is now live.

Anthony Petrone
Anthony Petrone
Managing Director at Mizuho Financial Group

Thanks for in here this afternoon. Hope everyone is doing well. Maybe a question, Mick, just on we're now into the fourth or fifth month here where we have GLP-1s in the marketplace. Lilly was out there sort of indicating that it was pushing at the primary care physician level. So just an update on the kind of state of the state as it relates to where GLP-1s are at the moment.

Anthony Petrone
Anthony Petrone
Managing Director at Mizuho Financial Group

And if you can opine on will this out of the gate actually open up the new patient funnel for CPAP as we think it will based on our channel checks? Thanks again.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Yes, Anthony, thanks for the question. It's a really good one. It's linked to that strategic question around demand generation. How do we get to the billion worldwide? How do we get to the 70 plus million in The U.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

S. Who are suffocating, where GLP-1s are rolling out the fastest? As you said, yes, look, with Lilly Direct and a lot of this sort of work that they do around their GLP-1s in diabetes, obesity and now with their new IFU for sleep apnea are investing in this space. They're not driving that sort of direct D2C campaign yet around sleep apnea. We believe they probably start that six months post somewhere between six and twelve months.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So we'll watch the space on that. But we're not waiting for them. As you heard in my prepared remarks, we're doing CME education and we're going directly to high volume GLP-one providers. We're going to primary care physicians who they will target so that they're educated and that they understand the gold standard treatment, CPAP, APAP, bilevel that you can get 95% to 99% reduction in AHI with the gold standard, right? All the clinical data, all the clinical literature.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

It's interesting, it's not branded. It's not even branded ResMed, CME can't. But we did those experiments because it's right for those doctors to know and it's right to educate them on gold standard and how it can be used in combination with other therapies like pharmaceuticals and dental and other alternatives as well. And so we're very open on that. We tracked that education to say, well, did we see a change in referral rates and or prescription rates through to sleep labs and IDTFs and into the funnel?

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And the answer is yes, we did see it. And so as I said earlier, we'll do brand development and demand generation, but it has to have an ROI. So early days, but ResMed's own demand generation, capture and curation elements are working and they are working not just in our traditional channels and in consumer, but they're working at primary care physicians at PCPs. And as we've said earlier, we're not going to target the 300,000 plus PCPs around. We're going look at the 10% that are high volume GLP-one.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We're look at the portion of them that already have existing relationships with IDTFs or Sleep Labs. And so we are working. We are seeing some movement. To your question of how materially will it open up the new patient funnel and how fast will that go? Well, ResMed's got a lot of models.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We're investing a lot, and obviously, that's pretty proprietary. But I can tell you that, as I said in the prep remarks, there's an ROI here. The CAC versus the LTV works. And so our goal is to scale it appropriately city by city, region by region, doctor by doctor. This is a very personal care.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Patients take their sleep apnea care very personally and having a really good relationship with both their primary care physician and their sleep physician is really important to ResMed. We're supporting all of our channels in driving this demand gen. So great question, Anthony, and we'll continue to update you every quarter as to how this is going with demand gen, demand capture and demand curation.

Operator

You. Next question is coming from David Lau from JPMorgan. Your line is now live.

David Low
David Low
Executive Director at JP Morgan

Thanks very much. Mick, I'm going to stay on the same topic. I mean, look at the device growth in this quarter, and know a quarter is a fairly short period, but we've seen a little bit of slowing. I heard the commentary that Sleep Lab's backlogs are bigger than ever. And then I see ResMed investing in night owl and focusing on perhaps a little bit more attention on the diagnosis channel.

David Low
David Low
Executive Director at JP Morgan

Can I get you to talk a little bit as to where you think market growth is? How much of a headwind or how much of a challenge the backlog in sleep labs is and what ResMed is doing about it, please?

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Yes, absolutely, David. Well, look, you've followed us for over a decade. And so you know over that time that we're sort of back to that traditional seasonality that we saw here in terms of growth sequentially versus and getting back to what we sort of have always had in the twenty five years I've been at the company, which is high deductible health plans, health savings accounts run through December and then a bit of a reset in March. But I can tell you, U. S.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Device growth at plus 6%, U. S. Masks growth at plus 14%, pretty darn solid numbers. David, look, it's very consistent with where we were last quarter, last five quarters, last 10 quarters where we said the actual market growth rate is mid single digits on devices, high single digits on masks. And that's if ResMed just accepts market growth, sits back and lets just suffocating people, their bed partners hearing them snoring, push them into the channel.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We're not going to sit back and do that. It's not how we operate. We're going out there, doing demand gen, doing these tests and getting things going. And so that's how we're beating what market growth would be at mid single digits and high single digits on devices and masks, respectively. To your point, going back to a normal seasonality, that means we get the benefits of sprinting through to the December too, right, as we go forward through this calendar year, and ResMed is looking at ways to do that.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

To your point, yes, we're looking at that backlog. We're looking at patients wanting to come through the channel. And we're looking at repap opportunities and resupply programs. So it's not just about new patients, particularly on our masks and accessories side. It's really about driving Brightree resupply, getting what we used to call Snap technology, but now calling resupply complete and resupply essentials out to every HME that is adaptable to a cloud based tech like that.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

I can tell you that their opportunities are huge and that we've got good tests that show we can get an ROI. As I've said before, I think we can accelerate above market growth by fifty, seventy five, one hundred, maybe even 125 basis points over that mid single digit growth of devices and high single digit growth of masks as we get more and more effective at this demand gen, demand capture and curation. We're not doing it alone. We partner with the primary care physicians. We're partnering with the sleep physicians.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We're partnering with doctors. And we're partnering with our HME partners. One note I'll say, just a final answer to this question is, we did this sort of direct to consumer empowerment in this last quarter and noting that on those sort of not late night television, all that sort of stuff, but some of our competing technologies are doing, but really focus social media and streaming where we know and have already prescreened that this is a high probability candidate for being a sleep health concerned consumer and somebody has a propensity, we're seeing them follow through and get referrals to primary care and to sleep physicians. And so we are going to be able to move on all these channels. Traditional sleep labs, home sleep apnea testing that they use and PCPs use and moving consumers into the channel.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

If we get any upside from the pharma and consumer wearable side, it will be in addition to our efforts. But we're taking the bull by the horns here, and we're driving the demand gen ourselves primarily. Thanks for the question, David.

Operator

Thank you. Next question is coming from Saul Hadassin from Berenberg. Your line is now live.

Saul Hadassin
Equity Analyst at Barrenjoey

Yes. Thanks for taking my question. Maybe just one for Brett. Brett, comments on the gross margin into the fourth quarter being sort of broadly consistent with this quarter. Just based on where the euro is now and also that the Aussie dollar was a bit softer in the third quarter, just wondering why your gross margin is not going to actually be materially higher in 4Q just based on those FX rates?

Saul Hadassin
Equity Analyst at Barrenjoey

Thanks.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Yes. Thanks, Saul. Well, yes, I mean, I've gone with broadly consistent that if you look at that margin, I guess that gives you a bit of room either side. And you're right, I believe we'll get some FX benefit if the euro stays where it is going into Q4. So probably the bias to that is north of what we printed in Q3.

Operator

Thank you. Next question is coming from Andrew Goodsell from MST Marquee. Your line is now live.

Dan Hurren
Senior Healthcare Analyst at MST Marquee

Good day. Sorry, it's Dan Haran here playing the role of Andrew Goodsell. We've had a few phone problems. Look, I just wanted to go back on the tariffs. Look, I understand that you've confirmed the exemption, but I was just wondering if that exemption will apply or extend to all CPAPA therapy coming into The U.

Dan Hurren
Senior Healthcare Analyst at MST Marquee

S. Because we had heard that one of your competitor sales reps is saying that they're pulling a couple of their Chinese made products on the back of this.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Dan, look, really good question. So look, this tariff work that we've been doing here at ResMed has gone back a long way. And if you look at the history of this, it was 1982 that this legislation was first put in place by the Reagan administration. It was reaffirmed in 1989 under H. W.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Bush. And then in 02/2009, ResMed actively worked with CBP, which is the Customs and Border Protection, to get official recommendation for us to be with some tariffs at the time then in February that were looking at being put in play. And we were given full tariff exemption then. We went back here in 2025 just earlier as you heard from Brett, just earlier this month and got reaffirmation that from Customs and Border Protection that our tariff exemptions apply under this protocol, sometimes called protocol. And we're fully there.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

As for our competitors, particularly coming from hotbed countries where tariffs are in the triple digits, I would ask you to go talk to them to speculate on that. I think it will be very different for players. We're coming in from Australia Singapore, Two very friendly U. S. Nations that have longstanding relationships and very good approaches.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

For those coming from China or Mexico or beyond, I think you've got to ask them and see where they're at. But yes, we've been at this for decades and we reaffirmed it just days ago, and we're running with it. And it's going to stay that way. I don't see anything changing on that. And if it does, we've got an incredibly strong balance sheet and all the other elements that we talked about earlier.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

But right now, we are running through the type and doing what we do, taking care of patients. And we're a U. S. Headquartered company. These reinvestments in Calabasas, in our distribution center in Atlanta, Georgia, we're looking at expanding our distribution here.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So really strong relationship with the U. S. Government, really strong relationship with the Australian government and the Singapore government. And those sort of public private partnerships that were tested during COVID, ResMed stepped up, and I think we've got really good relationships. I love being on the Board of Advamed and having the chance to go to Washington, D.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

C, to Brussels, to Canberra, Beijing and talk to these folks. I'm actually the chair elect of Advamed, which means on 01/01/2026, I take over as Chair of the Advamed Group. And so I'll be leading the industry, actually asking for tariff exemptions for medtech because I think it's the right thing to do. I don't need to beat competitors with a short term advantage. I beat them anyway.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And we'll fight to do those. It's the right thing on a humanitarian basis. But for right now, we are have our tariff exemptions in place, the ones we've had for decades reaffirmed just weeks ago. Thanks for the question, Dan.

Operator

Thank you. Next question is coming from Matt Taylor from Jefferies. Your line is now live. Thank you for taking the question.

Matt Taylor
Managing Director at Jefferies & Company Inc

Nick, I actually wanted to follow-up on that. You have this unique position with Avamed and it is great to see the Nairobi protocol still in place for your products. But I guess I was wondering, have you had any discussions or back and forth with folks in the government about broader exemptions for medtech? What do you think the chances are for that to be broader than just the historical harmonized tariff schedule under the current regime?

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Yes, Matt, look, it's a really good question. I was saying refer those specific country questions to my competitors. This one, I'd actually defer to the CEO of Abiomed, who's Scott Whitaker, who is the one negotiating directly with the White House. And obviously, we're all involved on the Board to do that. As I said, our goal there at Avamed is a zero for zero and a medtech exemption.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We haven't seen progress in that as yet. I've seen a number of my MedTech peer CEOs reporting and some of them are talking about quantifying their specific tariff hits that they're going to have, and those are there for them. They're not there for us. We've been able to have this and reaffirmed it. I will still I'll take the high road for the whole industry and advocate for that.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

The probability of success, I'll leave that up to you, Matt, and your amazing sell side folks to run your models on that. But here at ResMed, with our business, we're looking very good right now and we're just powering through this. I think our experience of going through global financial crisis, COVID crisis, supply chain crisis, our competitor out and we had to ramp up to the global manufacturing in Singapore, Sydney and Atlanta to where we are now has given us a lot of sort of stability and balance. And I would say, ballast in the boat and a stoic nature for our company. We're going to get through this stronger and better than ever, as I said earlier, not just survive.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We're going to thrive in environment. Challenges are challenges, but they bring opportunities for people who are ready. And opportunities is the overlap of everyone says it's luck when you get opportunities. And yes, there's return on luck, but opportunity is the overlap of there's something there and the preparedness of the company and ResMed is very well prepared. Thanks for the question, Matt.

Operator

Thank you. Next question is coming from Steve Wein from Jordan. Your line is now live.

Steve Wheen
Steve Wheen
Managing Director - Equity Research at Jarden

Yes, thanks very much. Question for Brett, just picking up again on the gross margin. You've obviously got a lot of those factors that you've been talking to for some time all pulling in the right direction at the moment. I'm just wondering what sort of runway you've got left to maybe be able to take that gross margin, ignoring your comments on FX for the moment, above 60%. So just trying to understand whether or not there's further shifts to sea freight and if there's further manufacturing efficiencies or maybe even better procurement going that is an opportunity in the future.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Yes, sure, Stephen. I mean, we're 59.9%, so we're shy we're almost at 60% now and we did see some pretty strong sequential increase in the GM as well Q2 to Q3. But as I mentioned in my prepared remarks, we do we're working on a number of initiatives. What we're really focusing on is building a good pipeline of margin improvement initiatives that we can roll out not just for a quarter, but sustainably take a six month, twelve month, twenty four month view on what we're doing. And if we build that pipeline of opportunities and then we execute on those then that should deliver those margin improvements year in year out.

Brett Sandercock
Brett Sandercock
CFO at ResMed

So that and the areas we focus on probably the areas I mentioned right is improving your manufacturing efficiencies and recoveries, distribution and freight and we've made a lot of progress there. So we've got that opportunity I guess is less now than what it was because we made a lot of progress, but there's still opportunity there to optimize on that. We're still running the AS10 and AS11 platform. We are transitioning. So every quarter we're moving more closer and closer to AS11 predominantly, although there will be a long tail in some markets on AS10 and it's still pretty popular product in the market.

Brett Sandercock
Brett Sandercock
CFO at ResMed

But that will help us. And then on procurement components, design for manufacture for new products for example that come through some of the work that we might do in terms of life cycle engineering and how we improve the products in market as well. So there's a number of opportunities we're looking at. There's not just one and it's not kind of here's one and that's easy and there you go there's margin improvement. But if you work on a number of items given our scale we will get benefit and we'll get improvement in the gross margin.

Brett Sandercock
Brett Sandercock
CFO at ResMed

That's certainly what our supply chain team is focused on delivering. And how do you do that? You do that by having a really solid long term pipeline of opportunities. As long as you're identifying them and executing on those, then I'm confident we can continue to expand the gross margin and get that gross margin. I mean, aim is to continue to improve it and that would logically mean it has to end up in the 60s.

Operator

Thank you. Next question is coming from David Bailey from Morgan Stanley. Your line is now live.

David Bailey
David Bailey
Equity Research Analyst at Morgan Stanley

Yes,

David Bailey
David Bailey
Equity Research Analyst at Morgan Stanley

thanks. Hi, Mick. Just interested in your latest thoughts on resupply rates for people who've or I would say patients who've initiated GLP-one therapy. Just wanted to test the thinking that patients who lose weight after being on a GLP-one might face their CPAP therapy. It's something that's sort of come from conversations, but interested to hear how you think that might evolve over time and then maybe sort of reflecting or referencing some of the patient engagement initiatives you've got?

David Bailey
David Bailey
Equity Research Analyst at Morgan Stanley

Thanks.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Yes, David, it's really good question. And as you know, we don't just hypothesize on this. We go and collect data, right? And so we're now tracking over one million patients and we see that high start rate on CPAP therapy for a GLP-one prescribed patient plus a PAP prescription. We see that high reimbursement rate at one year and we see a higher reimbursement rate at two years plus three and plus five.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And so plus 10, plus three, plus five, and we're tracking that and it's really consistent. Every quarter we'll put stuff into it and we're not really talking about it much because it's not changing that much in terms of these are very motivated patients. And as they lose the weight, I've been asked qualitatively and I've even asked sleep physicians like, give me the reason why, why are they more adherent? What do you think it is? And they talk about lifestyle, these people are eating better, feeling better, exercising more and therefore sleeping better.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

They also talk about the lower weight may for those on aPAP and vitals that are automated in terms of titration may be lowering their pressures, which can increase adherence as well. And so, lots of hypotheses out in literature. We're to see lots of clinical literature in this space. But David, the big change I think this quarter is I mean, if you look at the clinical data, a dental device might sort of seventy percent treat, an implant or a drug might half treat sleep apnea. There's only one gold standard that fully treats this sleeping disorder, this sleep suffocation disorder, and that is positive airway pressure.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And it's incredibly effective, completely non invasive and completely reversible. And so the risks for the patient are nothing. It's not like going under the knife for an implant or putting something into your body that could have all sorts of side effects. And so, yes, the propensity to start is low, and we're tracking really carefully that adherence rate. And we're getting good results there.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

So the real question is how fast will they bring people into the funnel and can we expand the funnel, the home sleep apnea testing funnel with Nite Owl, the Sleep Lab channel with better products like VpAP TX, more integration into SomnuWare, into Brightree, into Maya, into AirView. So we're sort of preparing the infrastructure, if you like, David, for the flow of new patients that will come from this. Yes, so the anecdotal, all people will lose a bit of weight and stop, it's just not happening. Talk to any patient, do the clinical research, look at the clinical data. If you don't believe our 1,000,000 patients in our study, go interview a doctor who says, no, absolutely not.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

They wouldn't think about it. They were actually doubling down on the use of it because they're feeling better across the board. And half treating suffocation is not treating suffocation. And the patients themselves know that, and certainly their doctors know that. There's always churn, but the churn is lower in that group.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

And our job is to drive up adherence programs, resupply programs, which lead to better outcomes. And now, from our data, leads to thirty seven percent lower death rates in the patients sticking to therapy, fifty five percent lower cardiovascular death rates. This is a big deal. Thanks for the questions, Dave. I think, Kevin, we're right at time.

Operator

We have time for one more question from Brett Fishman from KeyBanc Capital Markets. Your line is now live.

Brett Fishbin
Brett Fishbin
Vice President & Equity Research Analyst at KeyBanc Capital Markets

Hey, guys. Hey, thank you for fitting me in here at

Brett Fishbin
Brett Fishbin
Vice President & Equity Research Analyst at KeyBanc Capital Markets

the end. Just I'll ask one follow-up on

Brett Fishbin
Brett Fishbin
Vice President & Equity Research Analyst at KeyBanc Capital Markets

the gross margin trends. You called out manufacturing and logistics efficiencies as a primary driver of the sequential and year over year improvement. Just was hoping if you could maybe expand on like what some of the key initiatives in those buckets have been and where you're seeing the most impact.

Brett Sandercock
Brett Sandercock
CFO at ResMed

Yes. Sure, Brett. The on the distribution and freight, we're really seeing a strong improvement in our sea freight to air freight ratio. So that's improved a lot. So we're pretty close to where we were pre COVID actually.

Brett Sandercock
Brett Sandercock
CFO at ResMed

So that's been a strong driver, which has been there probably for the last twelve, eighteen months and that continues. So that's a big one there. Manufacturing efficiencies, you know what it's about doing a bunch of small things really well and driving that and improving your process, routing times for example. So doing a bunch of things looking at overhead and so on. You also get benefits of scale obviously as we continue to grow.

Brett Sandercock
Brett Sandercock
CFO at ResMed

And the other thing on that is the AS10 and even the AS11 platforms are quite mature now. So as they mature you get just better and better at making those devices and then you can improve along the way. In a sense continuous improvement programs if you like. So they really drive that and at our scale can have quite a significant impact. So that hopefully gives you a little bit more color on kind of some of the drivers there.

Operator

Thank you. We've reached the end

Operator

of our question and answer session.

Operator

I'd like to turn the floor back over to Mick for any further closing comments.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

Yes. Thanks, Kevin. And thanks to the over 10,000 risk medians providing these products and services that we talked about to patients in over 140 countries worldwide. Thanks for what you do today and every day. Thank you also to what you do for our patients, our physicians, providers, payers and health care communities and how you build value for our stakeholders, especially our shareholders who are listening to us today, which I know many of you ResMedians are shareholders as well.

Michael Farrell
Michael Farrell
CEO & Chairman at ResMed

We'll talk to all of our stakeholders here again in around ninety days. Thank you. Over to you, Sally.

Salli Schwartz
Salli Schwartz
Chief Investor Relations Officer at ResMed

Great. Thank you, Mick, and thank you, everyone, for listening. We appreciate your time and interest. If you have any additional questions, please don't hesitate to reach out directly. Kevin, you may now close the call.

Operator

Thank you. That does conclude today's teleconference and webcast. You may disconnect your lines at this time and have a wonderful day. We thank you for your participation today.

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