#309 Omnipod and Dexcom Updates

With the CCOs of both companies

Omnipod CCO Bret Christensen and Dexcom CCO Rick Doubleday are both on this jam-packed type 1 diabetes technology episode. Let's talk about automated insulin delivery!

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello, everybody, welcome to Episode 309 of the Juicebox Podcast. Today's episode is a little different than usual. It's two different interviews. The first interview is with Dexcom, Executive Vice President and Chief Commercial Officer, Rick Doubleday. Rick and I are going to be talking about things that are going on at Dexcom. And interoperability interruptible, inter Robin to interoperate. Oh, it's a word that you're probably hearing a lot around diabetes lately, but maybe aren't 100% sure how to say? Let's sound it out together in turn app for a bill, ed d. Hmm, that wasn't helpful either. Hold on one second. Okay, hold on, I'm gonna play it through my headphones into the microphone. Let's see if this works.

Unknown Speaker 0:51
interoperability

Scott Benner 0:54
the ability of a computer system or software to exchange and make use of information. So why do we care about that around diabetes, because the information coming from the dexcom continuous glucose monitor is going to help pump companies to build their own algorithms, right, like closed loop systems that will make insulin decisions for you. So we're going to talk about that from Dexcom perspective. And then go right into a conversation with Brett Christianson, the chief Commercial Officer of insulin. Insulin, of course, is the company that makes the Omni pod and the forthcoming horizon automatic its own delivery system, which is going to be the Dexcom g six, or the Dexcom g seven when it comes out. And the pods algorithm and their pump making insulin decisions for you. This is all very exciting. Here's the one thing you need to know. Rick and I are gonna go first, then it's going to be Brett and I. Brett was calling from Spain. So he's on a cell phone. There's a bit of a gap, right? Like I'd be like, hey, Brett, you're Brett, right? And then he'd say, pause. Yes, I'm Brett. There's a little pause. It's also a little cell phone Ian noisy. It's not perfect. I don't love that. It's not perfect, but the information is great. So I hope you can hope you can just you know, listen a little extra hard, you'll be alright, you can figure it out. It might not surprise you to know that this episode of The Juicebox Podcast is sponsored by Omni pod Dexcom and touched by type one.org. So you can go to dexcom.com forward slash juice box to find out more about the Dexcom g six continuous glucose monitor. You can go to my omnipod.com forward slash juice box to get a free no obligation demo of the Omni pod sent to you right now.

Bret Christensen 2:41
And

Scott Benner 2:42
touched by type one, of course, is dancing for diabetes. They've just changed their name, expanded themselves a bit. They're doing all the great stuff they were doing before plus a lot more touched by type one.org. I'm going to get started with Rick from Dexcom right now. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin. Here comes Rick. Rick Scott. Hey, how are you? Can you hear me? Okay?

Rick Doubleday 3:21
I'm good. How are you?

Scott Benner 3:23
Good. Thanks.

Rick Doubleday 3:25
Hey, yeah, Scott, can I ask you a quick question hundred

Unknown Speaker 3:28
percent.

Unknown Speaker 3:30
Did you?

Rick Doubleday 3:32
Did you send a story? A letter to Dexcom once upon a time right after Arden was diagnosed about what a difference seven plus had made and include her picture.

Scott Benner 3:44
Maybe? I'm not certain

Rick Doubleday 3:46
I am. I am 99% sure that you did. Because I used Arden's picture in a sale to our national sales team. It was one of the first patient stories I had. I had received I started here in 2009. Right, No, I know.

And,

and it was such an amazing story.

Scott Benner 4:10
I'm thrilled. I have to dig through my emails and find out. You know, that sounds possible, you know, prior to I don't know how to say this, I guess but prior to companies understanding the impact, I guess that users had on stuff and it probably wasn't you didn't understand it, probably you're just a tiny company with, you know, right. Not that much ability to delve into stuff like that. I I pretty immediately realized how valuable the data was. And we struggled greatly. I tell people this on the podcast all the time, but we struggled greatly with my daughters, they wouldn't see her stability, you know, shooting highs and crashing lows. For a number of yep for a number a number of years honestly. And then a woman My name Lorraine, who was probably another person who was kind of out in front of being vocal about diabetes at a time when not a lot of people were online. She just asked me if I, you know, had ever tried this Dexcom thing. And I said, my nurse practitioner just mentioned it to us. So it's funny when I tell the story, I tell it through my nurse practitioner, but the nurse practitioner brought it up. We were thinking about it. Lorraine brought it up, where I asked out loud, and she's the one that comforted me and said, that's a good idea. And now I'm talking to you now Arden has been eating lunch for the last half an hour blood sugar 77 like, you know, that's awesome. Yeah. Very onesies cemented in the fives. She does not have frequent or, or dangerous lows. A spike to us is 150. You know, the data is it's insane. It's It's just what it does. Yeah, I really appreciate it. I can't believe you've been there that long either.

Rick Doubleday 6:02
Right? Yeah. It'll be 11 years in June, right? Oh, that's been a lot of change.

Scott Benner 6:09
Yeah. Well, I bet Actually, I'm sorry. Just Just to let you know, I started recording before we talk. That's all okay. Is that all right?

Bret Christensen 6:17
Absolutely. Cool.

Excellent.

Rick Doubleday 6:20
How old is our now.

Scott Benner 6:22
So she's 15 at the moment, and she'll be 16. In July, she was diagnosed when she was two, it was literally a couple of weeks after her second birthday. So in August of 20, of 2006.

Rick Doubleday 6:37
Wow, that's really making me feel

Scott Benner 6:43
dexcom helps you not to, to feel quite as old when you're thinking it through the timeline of the technology. Because you guys have just leapt forward so many times, in a way that was prior unheard of in the diabetes space. You know, I don't think people will ever appreciate that. At some point. The Dexcom receiver did not have the ability to share blood sugars to the internet. So you guys built this little cradle so that at least overnight? Yeah, you could slide out your receiver into the cradle. And the cradle would you know, help people see blood sugar, so at least your kid was down the hall in another room in your bed, you could have these numbers. And I can't imagine how much effort went into making those cradles and putting them into the world? And I don't think it was, was it not even a month before the receiver that had Cher built into it was okayed by the FDA.

Rick Doubleday 7:36
It was a little longer than a month. But yes, we had a warehouse with a quite a few of the share cradle sitting in them after we launched the receiver.

Scott Benner 7:48
I joked with Kevin one time that I imagine that those cradles are business card holders on everyone's desks now.

Rick Doubleday 7:55
That's right. We often thought about maybe that would be a good use. It's funny that you say that Scott, I still I still have you know, those rubber bands that people wear around their wrist. Mine is share direct that was the codename internally for the receiver that allowed people to share their data off the phone. And I keep it there because I thought I believe it was such an immense step forward. And it was driven based upon feedback from customers what they were looking for. And this was, you know, our attempt to provide even greater a greater experience for for the users.

Scott Benner 8:37
Yeah, I found the most impressive part of that story business wise to me was, you know, I don't know what they all cost you to make them and develop them. But as soon as there was a better option, you guys have ended it walked away like he didn't foist it on us. Like, alright, well use these up, we already paid for them, you know, you were just like, okay, we we move faster than we thought we were going to with the FDA. So let's get to the better thing. And

Rick Doubleday 9:01
yeah, no, that is, that is absolutely the dexcom way, you know, it's consistent with our sensor technology, as we look at, you know, what it takes us to stand up all the manufacturing capability for G six, we're gonna have to do the same amount of work, because g seven is different. And we're gonna have to go through all of that, but it's the right thing to do.

For the users, it just is,

Scott Benner 9:29
is that what's going to, I mean, I think of you guys, as the leader in this space based on just the quality of the of the data that the product brings us back and the consistency, the consistency that it provides. And honestly, if I'm if I'm being 100% honest, just feedback that I see online. That is, I think, significantly better for Dexcom products, and it ends up being for the Libra stuff. But as Libra moves forward, and I'm assuming they're gonna change Trying to make their stuff better? How does Dexcom stay in that spot that they're in? Like, how do you hold the lead? I guess?

Rick Doubleday 10:07
Yeah, I think it's a I think it's a great question. I think it's, it's everything, Scott from how do we continue to make the technology better. So faster, warm up times longer length of time, of usage, robust, you know, 288 results, for the entire length of the sensor, all of those things we know are extremely important to the user. But it's also going to be a customer experience play. And, you know, similar to what we did with with share, follow, we understood that that was a really important feature, then we continue to add to that we went from five followers to 10 followers, we've totally re skinned it. We're actually in the process right now, of implementing the ability to message in the follow app, we had the Thanksgiving outage, which we were absolutely not happy about. And we knew we needed to find ways to be able to better communicate when situations happen. So that will be coming soon. The ability to actually communicate and let people know what's going on. So it's it's technical innovation, its scale, how do we make the tech services or customer support? process better? How do we provide a greater customer experience, we think that that's really going to be a differentiator, as we look to the future.

Scott Benner 11:40
So a couple of things. I'll start with easier one first, last night, I got a call from Dexcom. Because we've placed an order for new sensors. It's the beginning of this of the year. So you know, there's a check that has to be done. They got to go back to my insurance company and make sure everything's copacetic before they send this stuff out, happens every year, completely. So the phone call is it's pre emptive. It's, it's it's not I had to call in wonder someone called and said, Hey, you know, it's time to order. Do you want to do this? And I'm like, yeah, and then they said, Okay, so a couple days later, this other guy calls back ends up being last night. And we're talking and he says, we have to do a insurance verification. And they say, verification, he used the word that made it seem scary. Maybe it was verification, like you like, you know, we have to we have to do an insurance investigation investigation. He said, he said insurance investigation. And I'm assuming that's what he's been told to say and everything. And at the end of the call, I just said to him, Hey, real quick. I said, there's a better word, that investigation, and he said, What's that? And I said, it made me feel like, scared for a second. And I said, I don't know another way to put it. I'm like, but find another word. And and he's like, thank you. And I could hear him like, he's like, I'll make sure I say that to somebody. He's typing and everything. And I'm like, he's gonna tell somebody that, you know. And I really felt good about I think I forgot my wife came up with the right word. But But she, because I don't know, it was a weird thing. But I know the process. So when he said insurance investigation, I was just like, Oh, I know what's gonna happen. But it made me think about, what about somebody who this is their first time reordering? You know? Right? And maybe they'd be like, oh, what do you mean, an investigation is that, you know, we done something wrong like that. And it's just, it's a little thing. But it was met with, you know, it was met with comfort the guy, he thanked me a couple times, we started to have more human conversation, if that makes sense. Like, if we, you know, he might not off this script a little bit. And I thought, this is where things get worked out, like in these little moments, you know?

Rick Doubleday 13:45
No, and I think that's, I think that's a great point. And we do we really do listen to customers, and there was a, I still, I will still get emails, calls from customers good and bad when they have an experience. And I think the beauty of it is Scott, we I learned from each and every one of them. And we do try to implement those kinds of changes.

Scott Benner 14:11
Yeah, I mean, honestly, the, you know, you got to take your own advice, right. Like the, the data that comes back from the CGM is how I continue to make better and better decisions, how all these people do who have it. I mean, it'd be silly for you to ignore the data coming back as valuable. Right there a little. You know, that would just be ironic. When we were talking, we were talking about bettering the g7. You know, for the, you know, working on that. And first of all, it made me think somewhere at Dexcom. There's little wristbands that keep everybody motivated about g seven with some kind of code name on it. I'm wondering what that code name is. But, but the other thing I was thinking is, it is and Kevin's mentioned to me a couple of times, but its price point, the next hill to climb. Like like and just the disposable nature of the g7 does it begin to address that?

Rick Doubleday 15:04
I think that there is price point is absolutely a hill for us to climb, we know that we have to continue to make this technology less expensive to be able to make it affordable for a broader audience. And we are absolutely focused on that Scott, everything from working with the payers, moving the benefit from a DMV to pharmacy to ease the access. g seven, you know, will not be more expensive than g six, and we're continuing to focus on how we can make it less expensive. But there are there are so many other factors that g seven brings to bear just from, you know, I'll start with a simplicity from a simplicity standpoint, the fact that it is a fully integrated transmitter and center. So there's nothing snapping and snapping out, you just insert the entire unit. A faster warmup time, we're targeting 15 days. So there's just so many different features that we're looking to add at the same time understanding we have to continue to be focused on how do we take costs out of the system, right,

Scott Benner 16:23
those features you're talking about? Are they mostly? Do they mostly happen on the algorithm side? Like I'm assuming you make you know, maybe you're doing maybe you don't I make changes to like the sensor wire itself and and the physical technology, but is it more in the in the algorithm in in the way the information is being interpreted?

Rick Doubleday 16:46
Well, that's part of it. algorithm is absolutely part of the change. But again, we were talking about how Dexcom is willing to go out and make changes across the board. That's what we did with GE six, it was a you know, a new wire new membrane, and we're going to do the exact same thing with G seven as well. That's cool.

Scott Benner 17:09
That's excellent. I mean, I just got please.

Rick Doubleday 17:13
No, I was gonna say and I wanted to go back, you were talking about people wearing little rubber bands to keep themselves motivated around g seven, right. The beauty of that is we don't need the little wristband everybody in around this place is so excited to get g7 to market. You know, it's funny, you mentioned Kevin a few times and he gets absolutely giddy when he talks about g7.

It's, it is truly going to be

an amazing product g six is amazing. g seven is just another step forward for Dexcom.

Scott Benner 17:53
I'm, I'm super excited, is there timelines yet or not yet.

Rick Doubleday 17:58
We're still taught, we are still targeting 2021.

So, you know, we have to be, we have to be I know you and I talked to earlier, Scott about, you know, my time here from 2009 to two now. And you know, one of the big differences are installed base has, has truly grown. And we really have to be cognizant now of ensuring that we've got the right amount of product on the shelves and all of that before we go into a full blown launch, so that we don't get ourselves sideways, and delay launches and things like that. So you know, we are going to be very, very focused on making sure that this launch is our best ever.

Scott Benner 18:45
I think that under promise over deliver is definitely the way to think about stuff like this. You just, you know, there's no winning, if you say if you say April, and it's May, if you're you failed, if you say March and it's February, you're a genius, you know, so, yeah, it just it makes sense. Okay.

Rick Doubleday 19:03
Spoken like a true commercial person.

Scott Benner 19:06
I just you have to, you just have to, you know, you're gonna eventually take this amazing thing and lay it on people. There's no reason for them to start with it feeling like some sort of a letdown when it's clearly not that and that last piece, you know, is, is FDA so you don't ever know exactly the length of, of, you know, time. That's that effort it's going to take? Yep, yeah, that's it's really cool. So the reason I asked you to come on tonight, although all this has been really interesting is that I'm really interested in some of the agreements you just signed. And talking about, you know, closed loop systems or algorithm based pumping, I guess whatever you want to call it. I have I firmly believe that, that this is the way forward for a great number of people. I think that you take any algorithm based system And put it on somebody who's struggling, and they're going to suddenly be doing significantly better. And I think that ends up being, you know, kind of, sadly, the larger part of the community, like the podcast is great, but it talks to people a lot of times who are super motivated to do something. And you know, if you're talking to people who have, you know, who have an eight, they want it to be a seven, they have a seven, they want to be a six, but we don't often get to talk to people who have a 12 a one C and don't know what to do. And so I just think that this is going to be such a health game changer for such a large segment of people. And you're not. And by that I mean, Dexcom Dexcom is not limiting who in the pump community can use the technologies nears like Intel. So what have you done recently with? I guess, tandem and and their control like you? That's, that's on the market now. And then horizon from insolate, from Omni pod is coming. I mean, they're saying this year, right. So I guess talk a little bit about those agreements. First, when you sign like, like a commercial agreement with the pod, you did it for just the G six or the g7, the g7.

Rick Doubleday 21:15
No. So as we as we write these, what we call commercial agreements, typically starts with a development agreement, Scott. So we sit down and lay out kind of the rules of engagement as it relates to how we're going to develop products together. And it's really about who owns what in that development process. And the same thing with the commercial agreements. So as we write these commercial agreements, it is about how we now go about commercializing the commercializing these products. So you know, let's take the insulin agreement for a second. It will be an insolent launch, we are we're there to support where we can. We will, you know, work through various things from there may be co promotions there, there will be tools to jointly make the announcements. And that's what the commercial agreement is really about. I think what I'm most excited about about these agreements is we're actually getting the products to market that, as you talked about, products that change people's lives are truly becoming real. And the tandem control IQ was the first product, I can tell you that there are a number of people that work here at Dexcom that that use that product, one that I work closely with just talks about what a game changer, it has been loved bazel iq absolutely loved it. But now is seeing the impact on his nighttime highs that he'd never seen before. So these products are just like you say they're they're allowing people to get the benefits with with maybe a little less work. And that's what it's all about, how do we make this this disease easier for people to manage? We have always, we've always approached it, you know, we started at Dexcom with this philosophy of partnering with everyone because we're about providing choice. And, you know, we'll continue to look at that and for the right partners that have the ability to commercialize a product the right way we you know, we're always open to that as a potential opportunity.

Scott Benner 23:44
And that road goes both ways too. So like when weleda Yeah, when on the pod also does something similar with I think they're doing something with Libra but not for this current generation like they're doing I think they signed up with them too for like the Libra to moving forward. And and that to me, again, you know, I didn't just have you on here to butter your ass a little bit, but I'm imagining you could stop them from doing that if you wanted to. I'm imagine you could get in a room, close the door and go listen on the pod only works with Dexcom. That's what we want. And and they might be in the position where they have to go, okay, make dinner me like, I don't know, the inner workings of it. But I'm just saying that it's all working this harmoniously through these different, you know, user bases and products. It's it's very encouraging, because things just didn't go like that, you know? Right.

Rick Doubleday 24:41
Yeah. And I think it would be.

I would tell you, I think it would be disingenuous for us to go and do that. I think that you know, whether we could or we couldn't Scott and it wouldn't be the right approach. We went into this with a strategy of offering choice and in at the core We believe that the user should have choice and where where the rubber meets the road is, it's our job to make sure that we have the best product today where the, you know, I would challenge where the only real time continuous glucose monitor out there, Libra is in the market. But we're the one that provides a result every five minutes that allows patients to see their number, their trend era, you know, all agree. Yeah. And it's, it's our job to make sure that we continue to have the best product. And like I said earlier, also the customer experience is going to play such an important role. So customers will have choice, it's our job to make sure that we give them the best choice.

Scott Benner 25:43
Oh, you're doing it for my money. I'll tell you that much. And I wonder if I can ask a couple of different questions. So how do you handle when you're taking this? This thing, right? It's metal, and it's plastic, and you know, and you're fashioning it into this amazing device. And then you're putting it on a human being right. So now you're not just bolting it to a board or hanging it from a wall? You're, you're putting it into somebody whose body chemistry is different? Who is there? hydrations different? There's so many things individually about us that are different. How, how is that? Fine? tuneable? Like for somebody like my daughter who has nothing but success with Dexcom? And then you'll talk to somebody else who's like, you know, I get my period and it goes wonky. Now, it's not that it's it seems that simple from the outset. But how do you actually talk to that person and get them through understanding things like being hydrated so that the interstitial fluid moves around properly? And like, like all that stuff that we just, do you know what I mean? Like, is there a way forward for that? That kind of thing? customer education, or I was wondering what you guys do around that, or what you're thinking about for the future?

Rick Doubleday 26:57
Yeah, no, I think that's one of the things that

one of the things I think Dexcom does extremely well, Scott is, when you look at a lot of companies, you know, you find that the organization is pretty siloed. So r&d would sit off by itself, and they would, you know, create the next latest, greatest thing, marketing is out worried about promotion. And then you've got tech services, you know, our customer support that's in another silo, and they're sitting back and just answering the phone. We're a really integrated organization. So you know, first and foremost, when we are when we're creating new algorithms and new technology, we do a lot of small trials to really get good data to understand how the algorithms performing how the sensor is performing. And we have to do that before we ever take it to the FDA. Right. But it it doesn't stop there once the product launches. And we have the ability to see the data. Our r&d, and marketing and customer support centers are really tied together, they look at the complaints that are coming in. And they work together to figure out what is the right educational components to be able to provide to that user on the phone so that they have a great experience there was there was an example. Not long ago, where I had, I had gotten an email about somebody having an issue with a sensor, and was able to connect them back through to our customer support team. And they were able to walk this person through and it's so funny that you said it. It was really a hydration issue they were they were not hydrating as well as they could so talked about drinking more water. And that really seemed to make a difference for this individual.

Scott Benner 28:58
It's the little stuff you don't think of we we talk on the podcast a lot, because the person came on in and made this analogy one day, and he was an attorney from Canada. And so he said that there are some people who see a man put a pencil in his back pocket and then rob a bank and come to the conclusion that pencils cause bank robbery. And, and and, and you know, you put your CGM on your drinking, you know, a 10th the amount of water a human being needs in a day you don't get a reading back from the century like this CGM doesn't work. Well, right. You know, the CGM is reading fluid in your body and there's no fluid in your body. It's kind of a separate thing. Right? And but that's not your brain wouldn't jump to that being the user. It's always the pencil, you know, right. It's just It's very, it's very interesting. I've had some close contact with a friend of my daughter who has type one recently. And she would make these kinds of statements like oh, that's what my Dexcom does. And I was like, yeah, that's not really what's happening. Let me try to Like help you out here and we got our blood sugar down and stable and got her hydrated, and she's in a better, healthier situation. And now all of a sudden, her CGM reports back much more consistently than it had when her blood sugar was frequently over 400. And, you know, and her body was just going a different way. Now, you know, it's, it's, I guess it's interesting, really, you guys sort of started as a safety company right? In the beginning, you were just trying to make alarms so that people don't get too high or too low. And then, as the equipment the algorithm gets better, you become a decision making company, like, like the help of actually like when insulin goes in, so that now in this timeframe, it's more important than ever, because now these, the horizon algorithm is gonna be is gonna look at information from the Dexcom and say you need insulin or don't need insulin based on this number. I guess that ratchets the game up to a different level. Hmm.

Rick Doubleday 30:53
Yeah, I would agree. I think that

you know, we started out, and I spent, I spent 10 years at lifescan. Before Well, I spent 10 years at lifescan. And then three years at Animas before coming to Dexcom. So I, you know, I spent time in the self monitoring blood glucose face with one touch. And I think the thing for me, and really, one of the things that brought me to Dexcom was the differentiator that this technology provided, you know, you know, this better than I do, Scott, that a blood glucose result, a single point in time does not tell you the information that you need, and Dexcom with a real time continuous glucose monitor. Not only do I see the result, but I see the speed and direction. And I always believe that that was a differentiator, differentiator from a safety standpoint. But exactly what you're saying a differentiator as it relates to, you know, how much and when do I put insulin into my body? When do I not? And I'll take it the next the, you know, the next step, I truly believe that this technology has so much runway in front of it as it relates to individuals not taking insulin, because where else are you going to get a behavior mod tool that truly tells you the impact of the meds that you're taking, that you know, the therapy that you're on the impact of exercise, the impact of the food that you that you eat, I think all of those factors, there's just such a runway for this technology in the future. It's really exciting.

Scott Benner 32:37
No, I agree. I was actually just talking the other day with some I was getting physical therapy on my ankle. And the guy that was helping me was talking about how in his culture, there's a lot of type two diabetes all of a sudden, and he's talking about the things they eat being, you know, much heavier, more carbs, things like that. And how his mother is beginning to wear a glucose monitor. She's self funding at Dexcom. Because her husband got type two diabetes, and she's trying to figure out what foods are impacting her or trying to keep it from happening to her. It's really a forward thinking idea from a person. But yeah, that all exists. It really super does. So what is what's happening right now around Dexcom? Like, what mode? Are you guys in? I mean, I know you're supporting g six and that stuff, but is there like, what's your day like there? Are you trying to get stuff to Canada? Are you trying to spread out into Europe? Like, like, all this happened at once? And how much of that stuff do you have your finger on?

Rick Doubleday 33:44
So my day, let's call it hyper. Dr. Scott.

Yeah, I, so my accountability is global. So yes, all of the things that you just described, we, we've recently, let's, let's take a step back, let's start with the US for a second, we're getting ready to launch in probably the beginning of q2 quarter to our Dexcom Pro system. So this G six, so this will be a professional device that physicians will use. And they'll use it for type one type twos, and it's also the first CGM indicated for people outside of diabetes. And they'll use that within the Office. It's both blinded, meaning you can just use it if you're a physician, just as a tracker patient brings it back. I download the data into clarity, our software program, and I can make adjustments to therapy. It can also run in an unblinded mode real time, you know, similar to what Arden uses and a little bit more scaled back, but then that patient can interact with their diabetes and understand what's going on during that period. So we're really excited about bringing that to market outside the US. We've recently launched g six and the business is going extremely well. We are in GC, we're in, you know, g six, and a number of countries outside, we just recently got approval for GE six in Japan and Korea, and Australia. So the Asia Pac business is growing. So we're really excited about not just what's happening in the US where we're having, you know, tremendous growth is, is more and more people have access to this technology. But we're also excited about being able to offer it outside the US and we're in 40 plus countries now outside the US.

Scott Benner 35:45
Well, Joe, let me tell you that the podcast is in every country except for nine at this point. Most of them are right through the center of Africa, where the North Korea, there's only a couple of places people don't listen. And so I get emails that always start, Scott. Hi, I live in Saudi Arabia. I live in New Zealand, Scott, I'm in Australia, Scott, I'm in South Korea, and I want and it's either a Dexcom, or an Omnipod is the next thing they say how do I do that? And I I always giggle like when I read it. I'm like, I can't believe they've they think I know, but I'm like, okay, so. So I always get to my contact person. I'm like, Can I just forward you this email? And, and I know nothing's you know, listen, if you don't sell it there, you don't sell it there. But it's always my goal to make sure not that you don't know, but that you really, you really are aware that there are people, you know, all over the world looking for this stuff. It's so exciting that it's spreading like this.

Rick Doubleday 36:43
I agree. Yeah. No, it is it is really exciting.

Scott Benner 36:46
Well, so your day is long and tiring. And and do you? Here's a fair question. How many days and how many days end with you feeling like good day? mood for the most days go that way? Or? Like, like, what's that feel? Like? I guess I'm trying to bring people a little bit into, you know, like, it's easy for us to look from the outside and just say this thing I bought doesn't do what I want it to do. Nobody cares. Yeah, you know what I mean? Like, like, but there's a real person on the other side of the of the wall. And and they're, they're banging their head on that wall trying to get you that thing? You know, so it does most days it do most days at Dexcom feel positive, like like you're going in the right direction?

Rick Doubleday 37:29
Yeah, I it's a great question.

Yes, the short answer is yes, Scott, I think we're absolutely going in the right direction. I think that one of the things so I'm going to I'm going to take you back if you'll give me just a moment here. I'm going to take you back to I was actually at Animas at the time. And I had just started at animus. And my boss at the time says, Hey, I need you to go to a conference. I was first week on the job. I was leading the marketing team. He said, I need you to go to a conference. He said, okay, where am I going? Said conferences, children with diabetes in Orlando, Florida. My response was You do realize it's July, right? And he was like I do and you're going, so I'm like, Okay. And I went and I walked in, and I was handed my animus badge and I was walking down the hallway. And this woman who I had never met before, remember, I'm three days on the job at Animas, turns around, sees my badge and comes running to me, throws her arms around me and starts crying, sobbing saying you don't know what a difference you've made in my child's my child in my life. And Scott at at lifescan. It was a great company. And we did provide a tool. But I never understood the impact that the things that we made had on people's lives. And it was at that moment that I decided that you know what, as long as diabetes would have me, I was going to be focused on diabetes and not leave it. Then I got introduced to Dexcom. My last job was strategic partnerships and my personal relationship alliance with dexcom. And that's where I got to learn the technology, the leadership. And what Dexcom brought was this whole focus on the patient and the end user, which was absolutely what I believed in. And it was, and then with the technology, it was absolutely what I believed was the game. game changing technology second, only to answer One. So for me, it was an easy choice to join Dexcom that hasn't left here. So I know it's a really long winded answer to, yes, most days that I end up and they're long days, but they're really good days, because we're headed in the right direction. I take every one of those, you know, where we have fallen down and not provided what we needed to do. It hurts. But I know that we're working to make sure that that experience in the future is the best possible. And that's what keeps me motivated and brings me in here each and every morning. So long answer, hopefully, it was, you know, what you were looking for. But yes, I think I think we're absolutely headed in the right direction. The technology that Dexcom offers, in my mind is second to no one with our real time glucose monitor. It's what we are focused on. And we're focused on the technology and the patient experience. So I couldn't be happier about you know, the direction we're going

Scott Benner 41:03
well, I hope you get to say stay around the space for a really long time. So you can see it bear out in decades, because I interviewed a woman this morning, who's you know, toddler was diagnosed it baby even under two years old. And she found the podcast on day one, which led her right to index calm. And if you could see this kids graphs, this mother figured out the stuff I'm talking about on here, so quickly and so thoroughly. And so like, as I was speaking to her, I had troubled not wondering like, how much better this child's life's going to be over decades that might reach beyond my lifetime, even. And right and, and it's just really encouraging. I just, you know, Rick, you don't know me prior to this podcast, and diabetes and everything, but I sort of was not a Chicken Soup for the Soul person when this all started, you know what I mean? And now, I don't know if I am that. But I definitely have a really strong feeling for helping other people that maybe didn't exist in me before. And to hear somebody say something that that could to an outsider feel small, like, I'm able to concentrate while I'm doing my homework now. Or, you know, I thought I thought I was crazy, because my blood sugar would jump around. And my doctor would always say, you know, you're doing fine, but it didn't feel fine. Those little things. You know, the to a casual observer wouldn't seem like a big deal to me. They fill my heart up, like a woman once said to me, and there's a little bit of a curse in here, but not much. And it just I think it really shows the the intensity of it, she said that she thought her daughter was. And when she found the podcast and stabilized her blood sugar, and got her on the tools that we talked about here, she realized her daughter was a really lovely person whose blood sugar was bouncing all over the place. And I just thought when she said that, imagine if they would have spent their whole life thinking that about each other. And just right, what a sad shame that would be it just goes so far beyond just diabetes. I think sometimes.

Rick Doubleday 43:08
No, I agree. And I think and and the fact you're right, what their whole life could have been. But I think what's so exciting about that, that comment, Scott is what their what their life will look like, in the future. Because they the flip side, they could have been stuck in that mode for a really long time.

Scott Benner 43:24
Oh, no, I, I always come back to a single mom that I spoke to once in her late 30s, who had had diabetes since her teens, and was genuinely living with a 12 a one c forever. And then she said, you know, we spoke privately once and the next day she her blood sugar was between like 80 and 120. And she had a dexcom she had the tool, she just didn't know how to use it. And it just, there was this moment where she was grateful. But then for a minute, she got upset. And she said How come nobody ever told me this? You know, like, like, why is that not the standard of explanation and care in the space and and so the part that fills me with hope is that one day, I just hope that one day people are diagnosed, and they're told, hey, this glucose monitor exists, this is how an insulin pump works. Here's how insulin works now you can you can build off of that but at least you have those building blocks right there to start with instead of the fear and anxiety and you know, the your blood sugar starts jumping all over the place and you know, you lose you lose your personality. And before you know it you think it's it's it's hopeless. It's just a very slippery fast slope. You can fall down that hill and and never climb back up again. But it's just not necessary. So I hope one day that it just, I hope one day somebody that you know, the king of diabetes calls me and says Hey, everybody knows you can you can stop now. And you know and i i don't know what i would make a podcast about then.

Rick Doubleday 44:58
Yeah. I would be right. I, and I've said this before that, you know, nothing, nothing would make me happier Scott than a cure for diabetes. I'll happily go out of a job if we if we can solve this. I think in the meantime, you know, your comment about looking to the future, and being in this space for time to come. I can't wait for that teenager, adult that I meet in the future, that when I talk about doing finger sticks, has no idea what I'm talking about. Because they've been using a dexcom, continuous glucose monitor not having to do finger sticks. And it's ancient technology, like the rotary phone that I grew up with. That that's, that's, you know, the next thing I'm looking forward to

Scott Benner 46:01
when it just feels like you just said to them, Hey, did you you know, do you know, people used to have to boil their urine test their blood sugar, you know, like, like that guy stuff. You just just gone down? Hey, listen, what I'm going to do is I'm going to keep my Contour Next One ad off of this episode. I've I've done yet.

Rick Doubleday 46:22
I'm looking to the future. Don't

Scott Benner 46:23
Don't worry, essentially, it's gonna be a while from now. But no, no, but I, but I, Seriously though, I'm, I feel very lucky. You know, I started a podcast hoping to help people, the first month, it had a few hundred downloads. This month, it'll have no downloads. And, and I was very lucky that it was successful enough that I could pick and choose the ads I took, because I couldn't, I just don't know how I would get on this microphone, and talk about stuff that I don't believe in that I don't see doing. You know, the things that they're doing run by the kinds of people who I get to meet, you know, like you. And Joking aside that Contour. Next One is the best damn blood sugar meter I've ever used. And so that's, that's why they're the ones on this podcast, getting to talk about their meters, because trust me, they all wanted to be on the podcast, those are the ones I chose. And index comment on the potter right there with that, I just, it's just it's next level stuff. And the people, whether their voices being recorded or not, give me a good feeling. You guys, you know that that's how I feel when I walk away from a conversation with someone like you. I think I really believe you. I believe that if somebody tomorrow walked into your office and said, Hey, Rick, I got the you know, I got the cure to diabetes here. You know, you know what you want to put it in this in this drawer so we can keep this Dexcom thing going? I think you would say, you know what, we're all gonna have to find another job. Because, yep, you've met these people. And you know, what it what the disease does to them. So, yeah, that's excellent. I really appreciate you coming on. I realize we never set it in time. So as we're talking, I'm like, is he like, I gotta go or. But I really, I really do. I really do appreciate you coming and doing this. Is there anything? I know you probably did you just get back from Spain.

Rick Doubleday 48:20
I was not in Spain. I had team members there. I did just get back from your tie in about awareness, and which is still such an opportunity for us. So I appreciate what you do Scott, and helping drive that awareness. But I was had a chance yesterday to meet Sugar Ray Leonard. And he actually has a foundation, the Sugar Ray Leonard foundation. And he had his father who just recently passed away lifted the 94 had type two diabetes. So he has a real passion created this foundation that is connected with Children's Hospital of Los Angeles, and is about promoting awareness around diabetes. And the I think the thing that was so cool that he said was, you know, this is a guy that fought Marvin Hagler Duran, Tommy hearns. And he said, and he was sincere. He said, my toughest, the toughest battle I'm going to fight is fighting this diabetes thing. Because we've just got to find a way to make a difference. So I, I'm, I'm telling you that because I appreciate what you do as well to drive the awareness to let people know that there are solutions out there like Dexcom CGM, like insolate and that others are taking up that cause as well.

Scott Benner 49:57
So I appreciate what you do. Listen, it's Just a reflection of what I see working in my life with my daughter, and honestly is like I, it's you because you work it, you know what I mean? Like if it was somebody else, it'd be somebody else. But but you guys are the ones doing it right. So it's easy to talk about, I really appreciate it. Great. If I could say goodbye for a second, and would you hold on for just one second,

Bret Christensen 50:19
I would.

Scott Benner 50:22
We don't really need much in the way of ads for this episode. Let's just go over it one more time. If you'd like to get started with the dexcom, g six continuous glucose monitor, it would help me if you went to dexcom.com Ford slash juice box to find out more about the dexcom g six continuous glucose monitor, you want to know about the speed and direction that your blood sugar is going, you want to be ready for these great automatic insulin delivery systems that are here and on the way you just want to be healthier. You'd like for diabetes to be a smaller part of your life, these tools are going to help that dexcom.com Ford slash juicebox, there's going to be links in your show notes of your podcast player. And at Juicebox podcast.com. type it into your browser. But if you can, you know, hit my link, that'd be terrific. I don't get paid by the link, I don't want you to think that that's not how this works. It just lets the sponsors know that you're coming through the show. Also the Omni pod tubeless insulin pump, don't wait. Right? Don't get it into your head, like I'll wait for her eyes and just get the on the pod down Get going, you're going to be an absolute rock star stud with it by the time horizon gets here, and you'll make an easy transition to horizon, it's not going to be a problem. And by the way, if you don't want an automated system, you don't have to on the pod. They want what you want. In just a moment you're going to hear from Brett, and he's going to tell you that what Omni pod wants for you to have more than anything is choice. You'll see what I mean in a second. The great thing about on the pod of course is that they'll offer you a free no obligation demo of the on the pod right now, you don't have to buy it, you're not locked into anything. You just go to my Omni pod.com forward slash juice box, you fill in a little bit of information and they'll send a pump right to your house. It's non functioning, don't worry, can't hurt yourself with it. Give yourself insulin or anything like that. But what you can do is where you can live in it and see how you'll enjoy it. One of my favorite things about wearing the demo pod is that you just forget it's there after a little while. Touched by type ones mission is to elevate awareness of type one diabetes, raise funds to find a cure and inspire those with diabetes to thrive. They are my absolute favorite type one diabetes, charity. They're small, but they're powerful. And they're growing constantly check them out, just go to touch by type one.org. They're not looking for anything else from you. They just want you to know they're there. So you can see what they're doing. Touched by type one.org. And now, let's go to Brett Christiansen from the bot.

How are you?

Bret Christensen 53:29
Good. How you doing? Good. Where are you at?

Madrid Spain?

Scott Benner 53:37
Oh, okay. All right. How long you're there for?

Bret Christensen 53:42
all week. So I mean Friday morning. Nice. Thank you always. Great show.

Scott Benner 53:47
You're in Madrid. I'm in New Jersey, yes. Using a cell phone, which we don't usually do. But it's a big exciting kind of time. So we're making an exception.

Unknown Speaker 54:00
All right, so

Unknown Speaker 54:02
So, so you guys had a pretty big

Scott Benner 54:06
announcement the other day, I think it's sort of to me felt like a cementing of something we knew was coming as far as Dexcom. But the libri thing was a curveball for me. Can you tell me about that a little bit?

Bret Christensen 54:21
Yeah, I mean, I know that it should have been a curveball, because you know, the strategy all along right with interoperability is that you allow patients choice. And so we've been working for a long time with x calm. And as you know, we're launched on the pod horizon limited Dexcom g six. We announced last week that we're going to work together to quickly add g seven, which we know is important to our users. And then the abbot announcement was again, consistent with interoperability because, you know, what we do is we want to provide the best content delivery system out there. And so we're in the business of selling pods and pods marking pods. And so we want to allow patients, our users, sensors. And so if for whatever reason they want to use a Dexcom versus Abbott sensor, we see a product where you turn on your, your TPM, or you access the app from your smartphone. And there's a drop down box that says select your sensor, you're able to say that stop g six Dexcom g seven. That liberates you. That's the vision that we provide that choice to our users.

Scott Benner 55:34
And, and that Libra is not the current one that's available, though. There's one that's coming. That's the one that's going to work with.

Bret Christensen 55:42
Yeah, so the Libra shoe. That's right. It's the one that's coming. And and, you know, the real rationale for that is in Abbott said this bill working with the FDA to get ai CGM certification for Libra to as you know that that designates that CGM is an AI CGM. We've already been designated as an ace top. And then with horizon will be pivotal. But right now, we we intend to make the horizon algorithm the AI controller. So those are the three components necessary for an AI system. And what it actually does is it's a quicker to market pathway. So it's not a PMA product, it's not really going to add 10 kids, it's a it's a validation that the two companies should do together to make sure that that's actually works. odd. And with the rise in algorithm, it's a real short to market timeline.

Scott Benner 56:37
Not to jump around. But does that mean that tide pool also has to begin over? If they want to support the librato?

Bret Christensen 56:49
No, no, because, you know, the tide pool application is, is already being developed with the parks and effects job. And so that will just continue. So they, I guess, if they wanted to add lubri, to to that application, they could do so. But that system is being built with those three components in mind. And so then that comes g six is already an IC GM that they're working on is becoming the AI controller. And so they're working on that designation with the FDA, then they'd be able to pair that with Omni pod, the pump, those three components should be able to work together that system. I understand.

Scott Benner 57:29
Yeah, I didn't ask my question correctly. That's what I was asking. So Perfect. Thank you for clearing that up. So is it fair to say that? Is it fair to say that when horizon launches, Dexcom will probably be before Libra to where do you think Libra can catch up and get their designation in time for your launch?

Bret Christensen 57:50
No, I know, we're pretty tough. So when when we launched because we're again, we're in the trial now with Dexcom and Dexcom, kusik. So what we anticipate is that launch, which we've set it up for the second half of this calendar year, the system will be in the beginning, we will have full control on certain Android smartphones, there will be just the Dexcom gs six initially, and on the on the horizon algorithm. So that will be the component and that will be the system on day one. And then we'll look to add g7 and Libra to future developments. But there's still technical work that we have to do, even though the FDA does the clinical pathway to get there. Gotcha. And

Scott Benner 58:30
so, horizon. So I think this is a when I'm listening to people talk and ask their questions. And even just for the last two hours, I asked people, you know, that are following the podcast just on Facebook, like what would you be wondering? their questions, mimic them? I know a lot. But there were some interesting things I saw pop up where they just don't understand. So, you know, a lot of people said, Look, I can't get I can't seem to get a dash PDM. Is that going to stop me from getting horizon? Which led me to believe that they don't understand that horizon is going to be phone control, right? You're not going to need a PDM with horizon? Is that correct?

Bret Christensen 59:08
It's correct. But one clarification is that we will still distribute a PDF to every user. So even a user that says, Look, I want to I want to start off on horizon, using my own smartphone will still ship them a PDF, just as a backup device for that company we told the FDA to do. Yeah, so they'll have that right. So you don't need your need from control. For horizon, it will come Wikipedia, but anyone that chooses to just have the app on their phone, it can effectively eliminate one component of the system. So that's the beauty of phone controls. And you can do that. But but those that don't have an Android device don't want the app to want phone control, the ability to have a rising PDF,

Scott Benner 59:49
so horizon won't run off of iPhone.

Bret Christensen 59:55
Not initially. So again, that's the partnership with tide pool, but the one One of the real benefits that we get there, that's probably a shortage pack way to have Omni pod control through the iOS Apple system, because the tide pool application is built on exclusively iPhone. So it's probably the shortest path with Apple. But we have said that we are going to be working on an iOS version of horizon,

Scott Benner 1:00:21
I say, How are the trials going? Are they steaming along like you hoped? Are you learning anything from them?

Bret Christensen 1:00:31
Yet you also were blinded to the data. So we did a pre pivotal that started in December until almost the first of the year for a real small number of patients that we can have visibility to, will look to probably shoulder data potentially at ABA. But you have to be here on out we're really blinded to the data. So we'll get feedback from our investigators to fix even problems or issues that and then we see enrollment, but that's about it. So I will say this a Roman has been very strong. And if you talk to Dr. Lai, our medical director, she'll tell you that many investigators said they had people will fly from Texas to the Pacific Northwest to be in the trial. There was that much demand, so we won't have any problem during the enrollment for the trial. We know that much. But we don't see that the comfortable results and print the results until that Yeah. Okay.

Scott Benner 1:01:19
And so that you won't you don't get to see those results until the FDA comes back with a report for you about how they found the trial to be.

Bret Christensen 1:01:28
Yes, that's right. What we'll see it once it's complete in the data block and the results are in that's when we see it. We do get, you know, anecdotal stories I will have investigators will tell us how horizon has changed where their patients lives, there's, there's a story about a young patient that you know, had problems really wetting the bed, because the lot of rains, you know, the just that they couldn't keep the right, the right level. And that went away with almost immediately with the horizon. So there's some really cool patient stories, how it's changed people live, parents that are sleeping with their kids, a lot of that. But again, we don't see any time and range or you need to know clinical results. Until the completion of the trial. Do you do you see horizon as being for people who are really struggling? Only? Or do you? Or will it be able to be used by I don't know what to call it like a super user, somebody who's got a six and a half a one C and just really wants it to be a five and a half? Do you think that it has applications for for both kinds of people? Yeah, I do. I actually, I think it's for everybody. And and you'll see that is really stilted. So it's flexible enough that you could still be a super user. And really fine tune your time and arrange your will have set points from 110 to 150. But just the way it works is about you know, the beauty of CGM is it gives users really powerful information they can act on to try to get a real tight timing range. But they're not acting on that in a way that horizon writings getting a value from CGM from Dexcom every five minutes. And then it's making an interim dosing decision every five minutes or every five minutes that you've assumed a unique dose of insulin that's driving them to a target. That's just something that I could give it a power user on dash saves a hard time driving to that road. So I think it's for everybody, the ease of use and simplicity, it's gonna be great for somebody that hasn't wanted to adopt pod therapy. But I think it's flexible enough that a power user can get even better results on arrival.

Scott Benner 1:03:34
Are the are targets definable by the user? Or is it locked in it at at some target blood sugar

Bret Christensen 1:03:44
defined by the user. And so you can set different targets for different situations. But, you know, we wanted the flexibility with the lowest one. So that's the bottom set point. And if I want to do so, in increments of 10, so 141 5130 and 2110, those are the set points that are user defined. And then there's a you know, a feature like hyper protect, where, let's say you have a child that's going to sleep over or you're going to be exercising in some extreme way, you can set it too high for protect mode, which really kind of ignores that setpoint and lets you run at a higher rate for a longer period of time. And so this is something that we think is gonna be really valuable as well for this in situations. Okay,

Scott Benner 1:04:27
so I don't know if this is your space are not like I think I'm asking one of the right people. But, you know, dash came out in, I think in the within the last year and some people are able to grab it and some people are seem to be having trouble getting covered for it. And what I'm seeing is that that's causing people concern that they're not going to be able to get horizon moving forward. Is there a way to talk about the first I guess what what people should be doing if they want bash and if that has any impact on horizon

Bret Christensen 1:05:00
Yeah, let's back up as far as I can. So, you know, one thing we did with that, we really wanted to start over with, with the way that omsa reimburse the way patients pay for pumps and the way, they're restricted to migrate from one technology to the next. And so, you know, this, but the pump market historically has been a decision that it should make, there's a large upfront fee. For the pair case, of course, and other than patients pay for course, now, because of that large upfront fee, the pair had locked a patient in for four years to that piece of technology. That's troublesome. And it's actually it's not, it's it actually is a counter incentive to innovating and innovating quickly. And so a manufacturer like us actually has an incentive to only release a product every four years, because we have a large install base that can only adopt that new technology once every four years. And so if we hadn't done that, in which imagine patients actually digit cash, so we've spent over a year now, putting patients on dash from our legacy Omni pod product, those patients in the old model would be locked into a four year warranty carrier would not have access to horizon for the work through that four year period. So that that went away with that, because we did that, you have to renegotiate contracts in pairs. And so there are some users that have not been able to get gas because their pair will not pay for it in that manner. But the one existence that we made when we watch dashes, and we want to charge these large upfront fees, we also want to lock patients into a four year period. So the good news for those patients who's literally got gas yesterday, or still haven't got it, it has no bearing on their ability to get horizon because the baby launch horizon, the only thing that matters was real their pay or pay for it. And so it doesn't matter if they've had dash haven't had dash, none of that matters because it adopt that new technology, because you're not locked in to that four year period. And we're not going to build a pair for the largest selfie, that she's not paying up front. That's the good news. But that's been a shift, and it's taken us some time to build that access. Today, we've got over 50% of covered lives that have access to this new model. So we're not charging that fee. But if you're part of the the, you know, the 40 or 50%, that doesn't, we may have a problem getting on DAC so far. But that's getting better every day. But you know, the way I always talk about this, Scott is it's like cell phones were 20 years ago, you know what I had the key to Brian, they owned by phone number, they locked me into a three year contract, and I wasn't able to switch regardless of how poor my service was. And that's the pub market today, the the durable medical equipment, so we decided go away from that. So it'll be easy for patients to get on product that it's easy for them to get off, will not do a good job. That's the model that we see patients that choice, this choice of DVDs.

Scott Benner 1:07:50
So if I'm gonna make a hypothetical here, if I'm a person who can't get dash at, you know, for whatever reason about my insurance horizon comes out, can I just get horizon and use it with my phone? Or do I have to be able to receive the dash because the FDA thing like I'm saying, are the people who are are somehow blocked right now from dash? Will they also be blocked from horizon for that reason? Or do you think you'll have that straight by the end?

Bret Christensen 1:08:20
Just depends. But look, we're we're making progress on that every day. But what's likely is that their dash coverage will be pretty closely mirrored by the horizon coverage, because we all have the same payer, right? So pick pick a large commercial payer, and let's say they are paying for gas today, they're likely to pay for horizon when it comes out, right away, right, reimburse that, if they're not, for whatever reason, if it's a holding on to this four year locking period, and this larger, upfront fee, and we haven't been able to convince them that this new model is better for patients and frankly, better prepares. Because we assume that risks, we're not charging them for four years of therapy of swans, and they don't have to hope that patients use that product. So we haven't been able to do that yet. We need to do that between now and arising. Because it'll be the same model for a rising and so it again, it's a good thing, because horizon will be we're gonna be given a software company, right. And so as we innovate through software into applications, patients should always be able to adopt that newest version of horizon without having an upfront period, this four year locking period, but we just got to establish that access for them.

Scott Benner 1:09:24
So you're making an improvement a shift into the type of business you're doing, because of the improvement in the technology. But the insurance companies are stuck in, in the model they're in so you, is it a is a Yes. Is it a Is it an explanation thing? Do they not understand or they just resistant? Like, like, I'm assuming every day is frustrating when you're trying to make this work. But is there a path to it eventually do you think?

Bret Christensen 1:09:54
Well, yeah, and I. So let me let me say one thing, so you know, what I started with in 2003. years ago, we had been on the market for 15 years, and we were the worst reimbursed influence on the marketplace at that point in time. And so it took us forever to get to really good access with our legacy Omni pod today, you know, after just after less than a year of launching bash, we have better access to the ad, when I started with and slept with, after 15 years of work, it's actually happening very quickly, believe it or not, and most of the large parents have adopted it. But there's thousands of pairs, there's a lot of small plans, every state's got their own Medicaid. And so it's just a lot of work. And the story, we have to tell, thankfully, is a useful model that takes four pumps in the way that I described, locks up free Wi Fi for your locking period. So I feel like scratching the value of this new system, that value really is that we're owning the rest, because they only get outcomes, which they want. Because they get health outcomes. And they don't, it doesn't cost them very much if the user actually uses on the pod every day. And so they don't, because we didn't do the job of the product, then they stopped paying for it, then, you know, with the historical models, they pay for the front that hopefully, usually you got, you know, every patient from an average migrate between health plans every two and a half years. So why appear would want to pay for four years of therapy for anything knowing that on average, that that patient is going to stay with their health plan for two and a half years just doesn't make sense. So once we tell that story, it resonates with payers and the adoption actually very quick. We just have to, we just have to deal with it, we were the first to market and we were the first insulin pump on the marketplace. This is how reimbursement would have been set up. Here's what if it all paid for what the patient's using it for the benefits I'm getting, but they stopped using it, I want to stop paying for it, nobody would pay for four years of allergy medicine right up front, you know, you get that prescription filled every month, and that's okay, I just want to do. So they're they're migrating actions pretty rapidly. It's improving every day, it's just you have to tell the story and reach all those health plans.

Scott Benner 1:12:02
You know, it's funny, and I'm not known for being great at being like, office, correct, my wife always tells me if you had an office job, you would just get fired in a week. But so I'm gonna say this because I have, I have like historical, you know, time with on the pot, I've been working with them in one way or another for a really long time. And so I've had access in and had impactful conversations with people throughout the years. And what I can say is that, from my perspective, around five years ago, the leadership of Omni pod changed significantly. And I mean, through the actual people sitting in the positions, but also with the idea of what the company was for, like there was a time prior to JC that I thought this company might sell or even go out of business at some point, like I used to support on the pod because I loved it. And I wanted it to exist for my daughter. And I always felt like I always just felt like that leadership prior wasn't doing what I would hope they would do as a customer. And it is completely 180 degrees from that now. And it's, it's interesting. Because I have that perspective, I see how far it's come, how fast it's come and how the focus has become something that I'm excited by. But that's not exactly something you can communicate to people as they're coming in. And they're seeing, you know, tandem, put their pump out and it looks suddenly like their head when you don't know the whole story. It's it's an interesting, I don't know if you want to talk about that. But that's my perspective of it.

Bret Christensen 1:13:38
Well, I'll tell you the good thing about being able to state that we have the right to the entire management team, and that's just the executive level, but you're hard pressed to find anybody in it for the schedule longer than five years. The good thing about that is that, you know, we were in such a state at that time, you know, just how we marketed the product, how we sold the product, the quality of the product, the the amount that we were spending on r&d, or how little we were spending, frankly, on r&d. You know, when the new management team came in, it was pretty easy to take some risks because we had to, we had to do things dramatically different. And so we've done some things and the question I get asked so often is how are you willing to make these bold decisions and take these types of risks because frankly, some of them could not have worked out and ended up in a worse situation. But you know, we made the decision to move a large portion of our manufacturing from China to the US. That's a big decision which stood over $300 million automating the manufacturing lines and why as important you know, last year we made over 30 million parts until the quality has to be really really good on those that we have the opportunity to provide a bad patient experience bad news experience every three days. You know where you get a lemon when you buy a car once in a while. You don't buy a car every three days. We're effectively delivering a new pump to a patient every three days has to be done. Quality. So we put significant investment in that, we decided to disrupt the way the products paid for and to go to the pharmacy pays to go model that where patients don't pay for this large amount upfront, they're not locked into a piece of technology for four years, that's a long time, imagine not being able to upgrade your iPhone software for four years. It's silly, and it's not the way that it should be done. So that was a bold move. You know, we took our, our business back from our European distributor. So we went direct in a really short amount of time in Europe, which enabled us to expand beyond the small amount of European countries that we're in today to expand globally, there's just there's been a lot of things we've done in the finals, we took this was a good product, you know, an omni pod, and we're manufacturing with PDM is controllers with our own proprietary software. And we realize that there are companies out there that make pretty good handhelds called Apple and Samsung and these type of companies we moved on, we pocket this mobile platform, which took a lot of time, it was really risky, very expensive. But it's set us up now. And I appreciate that it's really all that work, it's just kind of coming to a close. Now, we haven't seen the result from a lot of it, but it's going to enable us to move really quickly in the future. And to innovate very quickly. And you know, the reason why I think users and patients only have adopted, you know, insulin pumps 35% of the time, which is probably the penetration rate of all type one patients in the US, that's a that's a visible penetration rate and usage rate, considering the insulin pumps have been around for 30 years, but the technology has not been good enough. And so if you're willing to give yourself four or five shots a day, that tells me that we just just have to do a better

Scott Benner 1:16:46
I am, I couldn't be more excited about where this all is. It's it's just it's tough for the, for the casual observer to understand the big picture of it, it's you know, and when you tell them, they just want nobody wants to hear it, you know what I mean? Like, everybody just wants it now, and, and they don't know, they don't know what had to happen. It's not like it's not like, it's not like you guys made a bad decision. Like you're making these, you're making these amazing moves. I saw the manufacturing floor. You know, I don't know if I ever shared this on here. But I came up and spoke to employees last year. And I was able to I was just there to tell them what Omni pod meant to my family. But I got a tour of the manufacturing and it is incredible. It's just it's people would not believe how on the pods are made. It's it's stunning. You guys are set up for you know, I was talking to the gentleman that set the floor up who I always think I want to interview because he seems so damn interesting. And, and, and he was explaining how you know how this setup allows changes to be made without like, huge tear downs from the manufacturing. And I was just like this is this is like state of the art. And you move that into the country. And and you haven't right there. It's right there. So I don't know, it just makes sense to me. I'm jacked up. I'm excited. So I hope

Bret Christensen 1:18:04
I'm excited to you know,

I get I get that it feels like we're not doing enough. I'm not doing it quickly enough. And I frankly I was there too. When I started with inside, why don't we just put an app on the phone that controls on Wi Fi, that's easy enough to do, right? Every 14 year old kid in America has got a video game on the phone that they built in their garage, that seems like it should be something pretty easy to do. But it's incredibly complex process and then never would really, you know, developing software that's going to deliver micro doses of insulin have to be incredibly accurate because insulin is a fantastic life saving drug that can be deadly if you don't do it. So it just there's a lot of scrutiny here and technology, not real quickly. I will say this, how can we estimate credit because the other we've always had the idea to put an app on a phone and control on the pond, but nobody ever thought that the FDA would get there would be comfortable with that. So you know, we've worked with them very closely to get there. I think once we get through these pivotal roles, and if we can get horizon approved on the marketplace, it's going to solve so many of the things that people are asking us for the number one request we get from a patient that still using multiple injections and they want an app on their phone. And if they could get an app on their phone, they put it on the playground and give it a shot. We can get to that. We're gonna we're gonna have a tremendous uptick of legalization because we know it's going to be a tremendous experience. You

Scott Benner 1:19:31
know, I can't tell you how many years ago it was where JC was telling me the very same thing. She's like, Listen, we want to put it on the phone. You know, we have to prove it out to the FDA, but it always felt like yes, we wanted to do it, but we don't I mean, it seems unlikely they're gonna say yes to this and that. That was a handful of years ago, but in FDA terms, it's quick, you know, and it's a big leap for them and you can see why. Especially how you described earlier like just how pumps have been forever. You know, to go from That sort of stagnant system to Hey here, it's gonna be on your cell phone is a is a major jump. Let me ask you a couple of quick hit quick heading questions here and see if you, um, if you have answers, I know you're saying the last half of the year, and you're a publicly traded company, you can't just give me a day. But do you think you're gonna hit in 2020?

Bret Christensen 1:20:23
Yeah, absolutely, we wouldn't be saying it, you know. So again, you know, we'll finish enrollment into the middle of trial, probably end of May, the latest will submit to the FDA, a little bit by 30 to 90 days, and then and then, you know, it's just a matter of doing some sort of relief at the end of the year. And so yes, I do think we'll hit it. And, you know, then 2021 will be all about getting as many people on really the best product on the market, which will be horizon. So we'll make sure that we're ready to do the, I'm glad that we've got the time. Because your point earlier, we've got, we've got market access to build further, even though we've made tremendous gains there, we've got supply to build, we've got marketing materials, we've got to make sure you have product support worked out, because now you know, we're talking about patients calling us and saying something's wrong with my system. And we got to quickly assess it to, you know, the way Dexcom is communicating with Omni pod is is the army product is the next commerce with something in between, and we just have to, you have to serve those goods. And so we're adding some complexity here on our ends, so that life is simpler for the user. And so we just got to figure all that out. But I'm excited for it could be one sided.

Scott Benner 1:21:37
I have a follow up for that. But first, it does Canada and Europe happening concurrently? Or will that take longer?

Bret Christensen 1:21:46
Not concurrently in the US will be first. And really just the it's the regulatory pathway for each individual country? And then you know, languages units of measure, but will they'll be fast followers, both of them? But but also the first,

Scott Benner 1:22:02
can I press you and ask you do you think 2021 for Canada and Europe?

Bret Christensen 1:22:10
You can trust me, I think. But you don't have to answer.

I just don't know if I can. I guess I don't I don't think we've hit that timeline out there. But I think I think they'll be fast followers.

Scott Benner 1:22:24
So you just mentioned something that I was going to bring up. So I've seen an algorithm work. And I've been in this space where I've tried to understand it. And what you just said about support is, it can't be stated strongly enough. So we we already live in a space where you know, and I see it more from the podcast than maybe most people do. But we already live in a space where most endocrinologist struggle to help people who are pumping or using MDI, to have the outcomes that they're looking for. And when you're using an algorithm, there are settings to consider. And if you don't have those settings, right, the algorithm, you know, you can't you can't tell a robot that there's a wall, eight feet in front of it, but the walls really four feet in front of it and expect it not to walk into the wall. And so the settings, you know, the parameters you put on it are incredibly important. But moreover, the way the algorithm thinks is unlike how most people are accustomed to thinking about diabetes, so the support is it's paramount. And I think that it's even more so maybe not just for people's success. But because I truly believe that algorithm based insulin pumping is what people should be doing moving forward and what they will do and what will be the best for them as far as their outcomes and their health and their stability and the amount of time they have to put into diabetes. But what I've seen is, is that when they try it, and it doesn't do what they expect it to do, and like it or not, their expectation is set it and forget it, which it's never going to be that right now. If you aren't able to shepherd them through the process, I'm so fearful that this really amazing advancement will will scare people away. And have you guys thought about it in that in those terms. I'm wondering

Bret Christensen 1:24:27
yes or no.

You're right about your stat. If something's not working in in, you know, one of the biggest challenges we might have is patient perception in their automated insulin delivery or artificial pancreas or how it's described to them. And we might think that they don't have to do much in one day. That might be possible. Because what we have done with the algorithms we have booted simpler, we're starting to make it make it so it's the parameters are set just right to the algorithm can compensate a little But for that, and so the algorithm gets better. And each one, you know, becomes faster actually, we'll be able to get better and better at that. And the goal will be one day to eliminate parameters, right. So that, you know, the reason why physicians have these complicated data management systems, and they're all budgeted out there, and they probably have all of them in their office, because they're looking at these reports, they're trying to achieve CGM values and influence those seasons. And then they're trying to fine tune these parameters. That's a real hard thing to do. And it's something that an algorithm should be better at doing in the future. But we're not quite there yet. We haven't eliminated all the knobs and the parameters that need to be set. So we do need to make sure that you train with just diligence and training, you know, this is going to be an incredibly simple system to use. And we'll move on to dash for existing users of Omni pod, have you provided online training, some patients do the content on training, because it's so intuitive, but they've been on pump therapy, so they know how important it is to know about your meals. important is to set the right base level, they know all these things. But if the pump gets easier and easier to use, we need to make sure that we're with justice, diligence and training. So we plan on doing that with horizon review. We do live training with our users and follow up in seven days, we call them 30 days, we bought the 90 days, just to make sure that they're just as guilty, because if they're not, and they look at this as an opportunity to do a lot less, they're not going to get the results that they should be getting improved results from arise. And so I'm excited about the future one day that I think I think we will get to the point where we can eliminate a lot of defenders because the algorithms that go in technological perspective, we're not there today. And so we just got to be very good at training and make sure that we take very seriously that the user has to do it, even though that's a lot easier with horizon.

Scott Benner 1:26:50
Isn't it interesting how you're on the cutting edge of something. And in its infancy at the same time, it's when you're making a leap like this, right? It's such a it's a weird headspace to be in because you're like, this is better than it's ever been. But with the way technology grows and leaps, two years from now, you'll look back at the first algorithm be like, Ah, you know, like, it's just, it's fascinating how quickly things move. And by the way, that's exciting. Yeah, because in diabetes, there were no leaps, just just five or six, maybe seven years ago, it was I say it all the time, you get excited if somebody made a new meter? And you say, is it more accurate? And they're like, no, but it's got a, it's got a color screen, you know, like that, and that excitement. So

Bret Christensen 1:27:40
it's just there's no other time, like, you know, what, what's interesting is, you know, expectations will just keep getting higher with our users. And that's okay, we're gonna live with that, right? You know, we would actually, it was a big leap from our legacy Omni pod to dash, we just, we, we launched the view app, right, where a parent can see what's going on with Omni pod for the child to the distance, you know, you should send your child to people, but you get to see what's going on within put on board and without me but but when that doesn't work exactly the way it's supposed to work, that people are upset, right, regardless of the fact that that didn't even exist a year ago, right. So so that's the way it will be is technology gets better expectations will just get higher and higher. That's great, though, because, you know, our mission is to improve the lives of patients with diabetes. And we will do that through technology use that looks like patients will be that that continues to get better over time. And well,

Scott Benner 1:28:32
yeah, I believe it will. I mean, I've I've got a long enough lines now that I've seen it in the past. And for everybody who's newer diagnosed or, you know, prone to be a little impatient, I guess sometimes. And for really good reasons. I'm just telling you, like, just hang on, like, I think ami pods moving in the right direction. And they have been for a really long time. This is just like another example of that. So I let me ask you, do you have to once your trials done, do you have to restart for a kid's trial? Or is that being done concurrently, so will pedes be available at launch?

Bret Christensen 1:29:10
So the trials going down to the age of six, so that should be available at launch, and then we will need to do more clinical work to lower the age glowsticks so could a you know Omni pod is cradle to grave. It's there's there's no limit on the age range. And we're the leader in pediatrics. So we also you know, there's an ad system has gone down to six today. And so we've, we were really, you know, emphasizing that to at least get to six in this clinical trial, but we're going to quickly get below six. We've got some data for patients down to the age of two, so we're going to have to get there. But yeah, at launch dance, your question would have been down to the age of six.

Scott Benner 1:29:54
Huge thanks to Rick and Brett for coming on the show. Rick Of course from Dexcom Brett from Omni pod. Another thank you to touched by type one.org for their support of the Juicebox Podcast and for what they're doing for people living with Type One Diabetes. You can check out the Dexcom G six@dexcom.com Ford slash juice box, learn everything you need to know. And get yourself a free no obligation demo of the Omni pod app my omnipod.com forward slash juice box. And of course, and of course touched by type one.org. Head over, see what they're up to. Now I'm gonna put this online, go to sleep, wake up, fly to Atlanta, and tell a roomful of people about being bold with insulin. You know who's gonna be there with me, Jenny Smith. Today's Jenny's birthday. I'm gonna see Jenny The day after her birthday. That's when I'm gonna meet her for the first time in person. Isn't that crazy? If I don't look too horrible. I'll take a picture and send it to you. But if I take that picture, and I think

Bret Christensen 1:30:59
No,

Scott Benner 1:31:01
no, then you're not gonna see Jenny on the day after her birthday. Hope you guys enjoy this. coming next week, part three of she's having a baby. Sam is about ready to burst and I just talked to her the other day. Things have gotten more difficult as the pregnancy has gone on. She's doing well. She's gonna come on and tell you all about it. I just remembered she likes being called Samantha but I don't feel like going back and editing it. So Samantha and good bye.

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