Glaukos Q3 2025: Contradictions Emerge on iDose Market Access and Growth, Epioxa's Revenue Timing, and Epiptera's Impact on Corneal Health

Date of Call: October 29, 2025

Financials Results

• Revenue: $133.5M, up 38% on a reported basis (37% constant currency) versus the year‑ago quarter; U.S. Glaucoma $80.8M up 57% YOY; iDose TR ~$40M in Q3; International Glaucoma $29.4M up 20% reported (17% constant currency); Corneal Health $23.3M up 13% (Photrexa $20.3M)

Guidance:

• Full‑year 2025 net sales raised to $490M–$495M (prev. $480M–$486M).
• Preliminary 2026 revenue guidance introduced at $600M–$620M; company will refine on the Q4 2025 call.
• Epioxa expected commercially available in Q1 2026 under a miscellaneous J‑code; permanent J‑code targeted by July 2026.
• Photrexa commercial availability to be discontinued during a 2026 stage transition, with temporary availability for patients lacking access to Epioxa.
• iDose expected to continue to ramp; market access and MAC engagements will affect adoption timing.

Business Commentary:

* Record Financial Performance: - Glaukos reported record net sales of $133.5 million for Q3 2025, up 38% on a reported basis or 37% on a constant currency basis versus the year ago quarter. - The growth was driven by strong adoption and utilization of iDose TR, along with growing contributions from the company's international infrastructure and product launches.

• U.S. Glaucoma Franchise Growth:
• The U.S. Glaucoma franchise achieved net sales of $80.8 million, demonstrating a 57% year-over-year increase.

• This was primarily due to the success of iDose TR, which generated sales of approximately $40 million in the third quarter.

• International Glaucoma Franchise Expansion:

• Glaukos' International Glaucoma franchise recorded net sales of $29.4 million, representing 20% growth on a reported basis and 17% on a constant currency basis.

• Growth was broad-based as the company scaled international infrastructure and executed plans to drive MIGS adoption globally.

• Epioxa Approval and Market Opportunity:

• The FDA approval of Epioxa marks a significant milestone, representing the first incision-free treatment for keratoconus, a rare sight-threatening disease.
• The approval is expected to expand patient access and drive substantial growth in the Corneal Health franchise as Glaukos initiates its launch plans, aiming to increase the number of diagnosed and treated patients.

Sentiment Analysis:

Overall Tone: Positive

• Company reported a record quarter: "record third quarter consolidated net sales of $133.5 million, up 38%" and raised 2025 guidance. Management highlighted FDA approval of Epioxa as a "significant milestone" and repeatedly emphasized confidence in commercial momentum for iDose and a strong balance sheet ($278M cash, no debt).

Q&A:

• Question from Thomas Stephan (Stifel): Can you discuss the rationale for the CAC meeting and potential outcomes from MAC conversations?
  Response: Management: CAC is an educational step to inform MACs of iDose's unmet need and robust Level‑1 evidence to support coverage and patient access.

• Question from Thomas Stephan (Stifel): Confidence in executing on Epioxa pricing with payers and how to think about 2026 Corneal Health given Epioxa ramp and Photrexa transition?
  Response: Management: Confident in payer engagement but expect a gradual 2026 ramp—site network build, misc J‑code early year and payer adoption headwinds mean a 'crawl, then walk' rollout for Epioxa.

• Question from Adam Maeder (Piper Sandler): Can you provide color on the $600M–$620M 2026 guidance midpoint and whether each segment should grow?
  Response: Management: The 2026 range is preliminary; company is confident multiple franchise paths (U.S./Intl Glaucoma and Corneal Health) can support it and will provide franchise detail on the Q4 call.

• Question from Adam Maeder (Piper Sandler): Details on iDose performance in the quarter and mix of standalone vs combination with cataract?
  Response: Management: iDose ≈$40M in Q3, growth broad‑based with ~80% volume from established MACs; NGS impact is delayed; company doesn't track mix precisely but combo cataract use is rising where reimbursement exists.

• Question from Larry Biegelsen (Wells Fargo): What data will you use to secure payer coverage for Epioxa and do you expect to grow beyond the ~10,000 Photrexa patients treated today?
  Response: Management: Will emphasize single‑administration clinical value and rare‑disease economic comparisons to payers; expect initial headwinds but plan to materially expand treated patients over several years (not immediate).

• Question from Larry Biegelsen (Wells Fargo): Could Epioxa reach large volumes (e.g., 20k eyes) in 2027–2028 and should we model the $78,500 ASP long term?
  Response: Management: Do not model $78.5k as long‑term ASP without accounting for Medicaid rebates (use a blended net price); growth assumptions should include required investments; company won't provide multi‑year volume/ASP guidance now.

• Question from Ryan Zimmerman (BTIG): How do you think about iDose ramp through 2026 absent CAC outcomes; is adoption linear or will there be an inflection?
  Response: Management: Early launch trend is roughly linear; a faster adoption inflection depends on successful MAC education and stabilized market access across payers.

• Question from Ryan Zimmerman (BTIG): The CAC questions imply studies weren't long enough—your reaction?
  Response: Management: Some CAC questions reflect misunderstandings; company expects to educate the committee on the extensive iDose data during the advisory process.

• Question from K. Gong (JPMorgan): If you obtain an LCD, how would that affect coverage with holdout MACs and prophy schedule?
  Response: Management: An LCD would aid coverage (including Medicare Advantage spillover) and could accelerate commercial uptake, but coverage and payment valuation are separate processes and outcomes are uncertain.

• Question from David Roman (Goldman Sachs): Please provide specifics on investments for Epioxa market development and timing of spend.
  Response: Management: Will run targeted, optometrist‑focused detection campaigns, digital outreach, expanded field programs, payer education and patient support; investments begin in 2026 and scale as site network and J‑code are established (H2).

• Question from Richard Newitter (Truist): Clarify components of updated 2025 guidance and what to model for Corneal Health and iDose sequential trend for Q4.
  Response: Management: Raised 2025 guidance to $490–495M; expect Corneal Health to show a material YoY decline in Q4 due to Photrexa→Epioxa transition, Intl Glaucoma low‑double‑digit growth, U.S. Glaucoma mid‑40% YoY growth, and continued iDose growth albeit possibly tempered sequentially in Q4.

• Question from Richard Newitter (Truist): Comfort on iDose consensus for 2026 and timelines for combination trials?
  Response: Management: iDose momentum is strong (Q3 ~$40M → ≈$160M run‑rate); franchise detail forthcoming on Q4 call; two Phase‑IV studies (iDose+cataract vs cataract and iDose+infinite vs infinite) are enrolling with potential late‑2026 to 2027 readouts.

• Question from Mason Carrico (Stephens): How are Photrexa volumes billed today—buy‑and‑bill vs specialty pharmacy and how much relies on book‑and‑bill?
  Response: Management: Photrexa is distributed via both buy‑and‑bill and specialty pharmacy; specialty pharmacy has grown materially but exact split not disclosed.

• Question from David Saxon (Needham): Cadence for commercial payer coverage in 2026 and strategy for placing/upgrading cross‑linking machines for Epioxa?
  Response: Management: Epioxa requires a new O2 capital system; company offers purchase/lease/swap options to minimize barriers; payer outreach is underway—many payers already accept cross‑linking but coverage timing is uncertain and will be updated through 2026.

• Question from Joanne Wuensch (Citi): What is included for Epioxa and iDose in the 2026 guidance—how should we think about contribution at the ASP provided?
  Response: Management: 2026 $600–620M preliminary range incorporates modest early‑year Epioxa contribution (limited access, misc code) plus iDose growth; detailed franchise breakdown will be provided on the Q4 call.

• Question from Michael Sarcone (Jefferies): How do you model the mix of iDose standalone vs combo cataract over the midterm (3 years)?
  Response: Management: Mix is surgeon‑dependent; combo usage may increase in the near term as easier combo cases are adopted, but long‑term opportunity is dominated by standalone interventional procedures.

• Question from Anthony Petrone (Mizuho): Update on FDA discussions for iDose reapplications and timing/read‑through relative to the CAC meeting?
  Response: Management: PDUFA for the iDose readministration appeal is Jan 28, 2026; company is hopeful but cautious—approval would remove the reimplantation contraindication and expand addressable market.

• Question from Danielle Antalffy (UBS): How is the iStent infinite standalone launch performing and where will standalone MIGS go in 3–5 years; what logistical changes are needed?
  Response: Management: Clinical buy‑in for standalone MIGS is strong; scaling requires changes in optometry referrals, OR scheduling, site logistics and reimbursement; over 3–5+ years standalone/interventional procedures should form the majority of the market.

Contradiction Point 1

iDose Market Access and Ramp

It involves differing expectations regarding market access and the ramp of iDose's adoption, which impacts revenue projections and strategies for Glaukos Corporation.

Can you explain the growth of iDose and the potential for a significant adoption increase? - Ryan Zimmerman (BTIG, LLC, Research Division)

2025Q3: iDose's ramp is linear, with growth driven by established MAC regions. The CAC meeting can accelerate market access and boost adoption. Our bullish optimism stems from this broadened market access. - Joseph Gilliam(COO)

Can you compare geographies where MACs fully cover iDose versus those not yet there? What are your timelines and assumptions for when these will ramp up? - Ryan Benjamin Zimmerman (BTIG)

2025Q2: Regions like Novitas, Noridian, and First Coast where professional fees are established saw over 80% of iDose volumes in Q2. We expect more MACs, especially NGS, to establish professional fees, boosting adoption and utilization. Ongoing advocacy and education efforts are set to continue as other MACs catch up. - Joseph E. Gilliam(COO)

Contradiction Point 2

Epioxa Revenue and Introductory Timing

It involves the expected timing and impact of Epioxa's revenue ramp, which affects financial forecasts and market expectations.

What data will you use to convince payers to cover Epioxa, and will patient numbers increase over time? - Larry Biegelsen (Wells Fargo Securities, LLC, Research Division)

2025Q3: Epioxa's pricing reflects a balance of clinical value and patient access. We expect it to compare favorably to other rare disease drugs. We aim to expand treatment from 10,000 to 50,000 patients, supporting that shift with patient access initiatives. - Joseph Gilliam(COO)

Are there additional details on full-year guidance for iDose, and when will Epioxa revenue start to increase? - Joanne Kane Wuensch (Citi)

2025Q2: Epioxa approval could lead to a short-term disruption as patients await it. Post-approval, we expect a significant portion of patients to defer until Epioxa access. - Joseph E. Gilliam(COO)

Contradiction Point 3

iDose Reimbursement Dynamics

It involves differing perspectives on the progress and impact of reimbursement dynamics on iDose adoption, which is crucial for the company's revenue growth and market penetration.

What components are included in the updated 2025 guidance, and how should we model the Corneal Health business? - Richard Newitter (Truist Securities)

2025Q3: iDose's ramp is linear, with growth driven by established MAC regions. The CAC meeting can accelerate market access and boost adoption. - Joseph Gilliam(COO)

How should we assess the cadence of iDose, particularly regarding MAC reimbursement progress and broader market adoption? - Unidentified Analyst (Wells Fargo)

2024Q4: We expect LCD headwinds to peak in the first half and ease in the second half. The impact will cause flat to potentially low single-digit growth in non-iDose U.S. glaucoma revenues for the year. iDose growth will be more significant, with contributions weighted towards the latter part of the year. - Joe Gilliam(COO)

Contradiction Point 4

iDose Market Growth Strategy

It highlights differing strategies and expectations for the growth of iDose, impacting market positioning and competitive dynamics.

Can you discuss the CAC meeting's rationale and potential outcomes? Can you provide views on iDose's performance and growth expectations? - Thomas Stephan (Stifel, Nicolaus & Company, Incorporated, Research Division)

2025Q3: iDose performance is broad-based, driven by MAC regions, MedVantage utilization, and new doctor adoption. - Joseph Gilliam(COO)

What trends did you see with iDose this quarter and any new factors or deviations from the plan? - Tom Stephan (Stifel)

2024Q4: The growth in iDose aligns with the broader market expansion in stand-alone treatment, rather than directly taking share from DURYSTA. The focus is on growing the overall market in line with the shift from legacy eye drops. - Joe Gilliam(COO)

Contradiction Point 5

Epiptera's Impact on Corneal Health Franchise

It pertains to the expectations and impact of Epiptera (now Epioxa) on the Corneal Health franchise, which could influence revenue projections and strategic focus.

What's your outlook for the 2026 preliminary guidance of $600 million to $620 million? Which components are expected to drive growth? - Adam Maeder (Piper Sandler & Co., Research Division)

2025Q3: We expect growth across U.S. Glaucoma, International Glaucoma, and Corneal Health franchises. - Joseph Gilliam(COO)

Can you break down the 2025 guidance by U.S. stent and iDose contributions? - Ryan Zimmerman (BTIG, LLC, Research Division)

2025Q1: Corneal health is expected to rise with Epioxa launch. - Tom Burns(CEO)