February 2026 issue
February 28, 2026 | At the 2026 meeting of the North American Neuromodulation Society in Las Vegas, Neurotech Reports editors, in conjunction with Nandan Lad from Duke University, produced a pre-conference workshop devoted to neurotech commercialization. The i3 program, which stands for invention, investment, and invigoration, is an opportunity for the neuromodulation community to explore business topics that aren’t generally covered in the meeting’s scientific sessions..
In a wide-ranging keynote, former NANS president Corey Hunter framed the neuromodulation sector at an inflection point, arguing that future innovation will be determined as much by reimbursement and advocacy as by technology itself. Drawing parallels to the evolution of the cardiac rhythm management industry, Hunter traced neuromodulation’s slower adoption curve to delayed payer acceptance and fragmented clinical voices, warning that history could repeat itself if the field fails to align.
Hunter emphasized that innovation, clinical necessity, and reimbursement are inseparable. “Without reimbursement, there is no innovation,” he said, underscoring why promising technologies often stall despite strong science. He cautioned that poorly designed outcomes studies and payer skepticism—already evident in spinal cord stimulation—risk constraining growth if the field does not proactively define value through real-world evidence and standards.
A central theme was the role of professional societies. Hunter described efforts during his NANS presidency to strengthen alliances with peer organizations and create guideline and advocacy infrastructure capable of influencing CMS, payers, and the AMA. Speaking to industry leaders in the room, he was blunt: “You can have the most amazing therapy in the world—if no insurance company covers it, what’s the point?” Hunter closed by urging stakeholders to “unite for growth,” aligning innovators, industry, and societies around evidence-based advocacy to sustain neuromodulation’s next decade.
Neurotech Reports senior consulting editor Jeremy Koff moderated a candid discussion on capital access, highlighting founders’ concerns around funding scarcity and signal to noise in investor outreach.
Nick Langhals from the NIH provided a pragmatic view of federal funding in this time of uncertainty. He emphasized accessibility, noting, “We are mostly approachable,” and encouraged innovators to share concise project summaries. Langhals stressed realism in matching stage to mechanism, warning that “coming in and saying, ‘I need one hundred million dollars for a scratch on a napkin,’ probably is not going to go over so well.” Despite the lapse of small business set aside programs, he underscored that “there always is some place that you can apply,” urging teams to stay nimble as priorities shift.
From the venture perspective, Jeff Chu of Features Capital painted a stark picture of early stage competition. “Nine venture firms got 50% of all the venture dollars,” he said, adding that “40% of all of our venture dollars went to AI companies last year.” Reviewing roughly “six to eight hundred deals a year” and investing in only four, Chu argued that standing out requires deep understanding of patient-provider-payer dynamics and longterm investor–founder alignment.
In a subsequent session moderated by Koff, industry leaders debated how noninvasive neuromodulation companies can translate strong clinical science into scalable, reimbursable businesses. The discussion highlighted divergent but complementary commercialization strategies spanning clinic-based capital equipment, consumer-facing wearables, and durable medical equipment, underscoring a field in rapid strategic evolution.
Ken Mariash, CEO of Sinaptica Therapeutics, framed noninvasive neuromodulation—specifically closed-loop TMS-EEG for Alzheimer’s disease—as precision medicine at the network level. Mariash emphasized CPT-based reimbursement, quarterly calibration, and biomarker-driven feedback as the foundation of a sustainable capital equipment model. He argued that predictable, high annual reimbursement per patient could support national sales force expansion while offering neurologists a compelling new profit center. As he put it, “It’s the definition of precision medicine—we’re precision medicine at the connectome level.”
Colin Kealey, CEO of NeuroSigma, described a contrasting strategy rooted in consumer-scale economics. Drawing lessons from Abbott’s FreeStyle Libre, Kealey outlined a vision for wearable neuromodulation devices distributed through pharmacy channels, emphasizing high margins at consumer price points. NeuroSigma’s external trigeminal nerve stimulation device for pediatric ADHD, already FDA-cleared, is being supported by larger randomized trials and biomarker research to broaden indications. “The beauty of wearables is that they fit very nicely into the pharmaceutical distribution model,” Kealey noted.
Amy Baxter, founder of Harmonic Pain Solutions, brought a pragmatic, clinician-driven perspective shaped by years of practice. Her company’s DTC neuromodulation devices gained early traction through word-of-mouth and Amazon availability. The current focus is on her Duotherm prescription device shifting toward workers’ compensation and prevention markets while navigating the challenges of DME reimbursement. Reflecting on adoption barriers, Baxter observed, “You can come up with a solution and prove it—and it falls like a pebble with no ripples.”
Closing the session, Koff struck an optimistic note, concluding, “I am very bullish about noninvasive neuromodulation. Once the business model gets refined and reimbursement follows, you’re going to see more successes.” The panel made clear that while paths to market differ, noninvasive neuromodulation is steadily maturing into a durable neurotech business sector.
In a deliberately provocative talk, Peter Konrad of West Virginia University made the business and clinical case that implantable brain devices—particularly deep brain stimulation—remain not only relevant but strategically advantaged, even as noninvasive and lesion-based technologies gain momentum.
Konrad framed his remarks around a central tension facing the neuromodulation field: while high-intensity focused ultrasound and other “one-and-done” lesioning approaches are attractive to patients and payers, they lack the adaptability, reversibility, and long-term safety profile that have allowed DBS to endure for more than three decades. Drawing on historical perspective from early DBS pioneer Alim Louis Benabid, Konrad emphasized that adjustability and bilateral therapy were core design advantages from the very beginning—and remain so today.
He argued that implants should not compete head-to-head with drugs or lesioning on short-term efficacy alone, but instead on durability, side-effect management, and economic value over time. DBS, he noted, has demonstrated sustained benefit over 10–15 years across Parkinson’s disease, tremor, dystonia, and other indications, with no tolerance effects and a favorable quality-adjusted life year profile. “If you turn the device off, it’s as if nothing’s there,” Konrad said, underscoring the reversibility advantage over permanent lesions.
From a business standpoint, Konrad highlighted rising biologics costs as a structural opportunity for devices, particularly as adaptive and AI-enabled stimulation reduces programming burden, side effects, and battery consumption. He also challenged the industry to rethink regulatory and commercialization models that force single companies to prove single devices for single diseases, arguing instead for more modular platforms and cross-company collaboration.
Perhaps most provocatively, Konrad proposed noninvasive ultrasound not as a competitor, but as a potential ally—a way to trial new brain targets noninvasively before committing to implantation, akin to spinal cord stimulation trials. “What we’re missing in brain implants is a noninvasive way to prove the target before we put wires in people’s heads,” he said.
Looking ahead, Konrad forecast that devices will comprise the majority of functional neurosurgery procedures within the next decade, driven by aging populations, smarter implants, and growing demand for nonpharmacologic therapies.
