Oct 28, 2026 earnings call — Record sales driven by Epioxa and iDose
Glaukos reported record third quarter consolidated net sales of $211 million, up 58% versus the year ago quarter.
Revenue $0.2B (est $0.2B) · EPS $0.47 (est $-0.10)
Key quotes
"We remain very encouraged by the early progress of our commercial launch of Epioxa as the first and only FDA-approved epithelium-on corneal cross-linking therapy for keratoconus."
"The study achieved its primary endpoint, demonstrating statistically significant superiority in a clinically meaningful IOP reduction compared to cataract surgery alone with an 11.1 millimeter mercury mean reduction in IOP and a 3.6 millimeter mercury incrementally superior treatment effect at 3 months."
"As a result of our third quarter outperformance, we are raising our full year 2026 net sales guidance to $775 million to $785 million, an increase of $90 million at the midpoint over our prior guidance of $680 million to $700 million."
Analyst Q&A 12
How Epioxa and iDose affect 2027 guidance
Q (Thomas Stephan · Stifel): How do Epioxa and iDose layer into the $1 billion 2027 revenue target, including possible iDose LCD effects and early Epioxa ramp? Why did you decide to give guidance now and what gives you confidence?
A: They will not break down franchise-level details now and will do that next year. They evaluated many scenarios, including downside from an iDose LCD, and still saw a path to $1 billion, which gave them confidence to give early guidance.
"And so as we evaluated that, we felt confident that we could actually put that number out there for you all to digest." — Joseph Gilliam (COO)
Epioxa launch progress and payer access
Q (Adam Maeder · Piper Sandler): Can you give more launch metrics: number of accounts doing Epioxa cases, prior authorization approval dynamics, payer approval rates, and whether market awareness initiatives have started?
A: They said Epioxa contributed $53 million in Q3 and they are encouraged by underlying fundamentals. They now have systems deployed that serve about 90% of the U.S. population, have >200 established sites with contracts to expand beyond 300, and have open payer pathways for 90% of commercial lives and 80% of Medicaid lives; awareness investments ramp in 2027.
"And as you heard, we now have systems deployed as of in the third quarter that serve about 90% of the U.S. population." — Joseph Gilliam (COO)
Timing to reach prior treatment volumes
Q (Larry Biegelsen · Wells Fargo): Can you get back to the 18,000 to 20,000 eyes by 2028? What epidemiology supports the 50,000 to 100,000 patient estimate?
A: They said it is a big step from early Q3 results to those historic volumes and they will not give a timing prediction. They remain confident the market can grow and have discussed a potential broader 50,000 to 100,000 patient opportunity, but would not commit to a timeline.
"I'll stop short of giving a time line prediction on it." — Joseph Gilliam (COO)
Expanding user base and margin durability
Q (Ryan Zimmerman · U.S. Bancorp BTIG): How will you move beyond high-volume cornea specialists to broader adoption like Photrexa? And are the Q3 gross margins durable at those levels?
A: They said they were methodical, focused on skilled, higher-volume centers and geographic reach, and also have over 700 detection centers to screen patients and refer to treatment sites. They also said Q3 gross margin expanded to almost 88% and they expect margins to be durable as Epioxa and iDose become larger shares of revenue.
"As far as durability, we wouldn't expect it to not be durable, given the fact that Epioxa and iDose continue to be the 2 most transformative revenue growth drivers." — Alex Thurman (CFO)
SG&A outlook and M&A vs R&D
Q (K. Gong · JPMorgan): How should we think about SG&A in Q4 and for 2027 on a dollar basis? And what kinds of opportunities would you develop internally versus pursue externally?
A: They said commercial investments have been building and a material pickup in disease and brand awareness spend is planned for 2027. They guided Q4 operating expense growth of 25% to 30%, full year 2026 operating expenses around plus or minus $630 million, and emphasized an organic-first R&D strategy while still evaluating external deals that fit the pipeline.
"I would guide you to say that growth rate should be 25% to 30%." — Alex Thurman (CFO)
Buy-and-bill channel build-out
Q (Mason Carrico · Stephens): What percentage of Epioxa volumes came via buy-and-bill in the quarter, how has the buy-and-bill build-out tracked expectations, and how will it accelerate adoption?
A: They expected buy-and-bill to lag specialty pharmacy but said the buy-and-bill network has been increasing rapidly, especially in the last 30 to 60 days, across strategic accounts, physician offices, hospitals and larger institutions. They view buy-and-bill as an important and growing contributor as they scale.
"I will say, our network of sites that are buying and billing Epioxa has been increasing rapidly and particularly over the last 30 to 60 days." — Joseph Gilliam (COO)
iDose trends and possible pull-forward
Q (Michael Sarcone · Jefferies): What trends did you see in iDose in 3Q and expectations for full year? If an LCD is restrictive, would doctors pull volumes forward?
A: They reported $76 million of iDose revenue in Q3, driven by fee-for-service in the NGS jurisdiction and growing Medicare Advantage and commercial contributions, and expect iDose to reach into the low 280s for the year. They said a restrictive LCD might prompt some customers to try to act, but many customers are busy in Q4 and may be challenged to pull volumes forward.
"And so their ability, necessarily, to make a hard pivot in advance of any LCD coming into play would be challenged by that fact." — Joseph Gilliam (COO)
LCD timing and MAC process
Q (Joanne Wuensch · Citi): Is an LCD likely or not, and is there a deadline by which we should stop expecting one?
A: They said there are no new updates and that MACs must act or abandon an LCD within 1 year from the date of their draft (which was May). If a final LCD is proposed it then has a 45-day waiting period, and they are monitoring how MACs digest the evidence submitted.
"To the heart of your question, the only statutory obligation that the MACs have is 1 year from the date of their draft, which was May, to act or abandon the LCD." — Joseph Gilliam (COO)
Epioxa net ASP and study impact on LCD
Q (Richard Newitter · Truist): What should we model for Epioxa ASP for back half of 2026 and 2027? And how will new studies influence the MAC LCD decision?
A: They described a Level 1 multicenter study showing additive benefits of iDose and said such studies serve both to validate clinical value for customers and to support reconsideration requests if a restrictive LCD is issued. They continue to advise assuming a $65,000 to $70,000 net ASP for Epioxa for modeling purposes.
"I think we've been pretty consistent in saying to assume in your models a $65,000 to $70,000 net ASP." — Joseph Gilliam (COO)
Keratoconus screening device rollout
Q (Steven Lichtman · William Blair): Where will the KC screening device be deployed (optometrists, screening centers)? How will it accelerate referrals and build the network?
A: They plan to deploy screening devices broadly to detection centers and optometrists to democratize screening and expand access to diagnosis. The device is meant to screen at scale across the many optometrists in the U.S., then refer positive screens to treatment centers and support patients through the hub and specialty pharmacy.
"As we think about the detection centers and the KC screening device, the job there is to democratize screening, right?" — Joseph Gilliam (COO)
LCD assumptions in the $1B guide
Q (David Saxon · Needham): If the MAC LCDs finalize, will iDose be flat in 2027 and how are LCD scenarios built into the $1 billion guide?
A: They said the $1 billion preliminary expectation for 2027 factors in all scenarios, including a MAC LCD as currently proposed, and they remain confident they could still achieve the $1 billion revenue number. They will not give more specific point estimates until they see what actually transpires with any LCD.
"We remain confident that we could still achieve that $1 billion revenue number in the year." — Joseph Gilliam (COO)
Prior auth delays and EpioxaCareConnect role
Q (Anthony Petrone · Mizuho): Some plans have extended prior authorization timelines despite demand. What opens those up and how does EpioxaCareConnect and specialty pharmacy ease the logjam?
A: They said longer prior authorization timelines are normal early in a rare disease launch because payers learn through the process, and efficiencies come as volume and approvals accumulate. They use the hub (EpioxaCareConnect), specialty pharmacy partners, and buy-and-bill support together to help providers and patients get approvals faster over time.
"But ultimately, the way you get to a place where it operates more efficiently is through volume, right?" — Joseph Gilliam (COO)