Glaukos outlines $600M–$620M 2026 revenue outlook as Epioxa launch and iDose TR drive growth

Earnings Call Insights: Glaukos Corporation (GKOS) Q3 2025

MANAGEMENT VIEW

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CEO Thomas Burns began by highlighting "record third quarter consolidated net sales of $133.5 million, up 38% on a reported basis or 37% on a constant currency basis versus the year ago quarter." He announced an increase in full-year 2025 net sales guidance to a new range of $490 million to $495 million, raised from $480 million to $486 million previously, due to strong performance.

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Burns detailed the momentum from iDose TR, noting "growing iDose TR adoption and utilization, along with our broader Interventional Glaucoma, or IG, initiatives globally." He stated that "iDose TR, a first of its kind intracameral procedural pharmaceutical designed to continuously deliver glaucoma drug therapy for up to 3 years, continues to build commercial momentum."

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He emphasized the FDA approval of Epioxa for keratoconus, calling it "a groundbreaking advancement in corneal cross-linking for the treatment of keratoconus." Burns described Epioxa as "the first and only FDA-approved topical drug therapy that does not require removal of the corneal epithelium."

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Burns revealed, "we have established a wholesale acquisition cost for Epioxa of $78,500," and outlined a strategy to prioritize Epioxa over Photrexa, which will be discontinued following a staged transition in 2026.

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CFO Alex Thurman highlighted, "continued gross margin accretion and maintain a strong balance sheet with $278 million in cash and no debt."

OUTLOOK

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Glaukos raised its 2025 revenue guidance to $490 million to $495 million, citing its third quarter outperformance and continued underlying momentum.

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The company introduced a preliminary 2026 revenue guidance range of $600 million to $620 million. Burns stated, "this preliminary outlook factors in our expectations as it relates to the continued commercial rollout for iDose TR, the surgical MIGS landscape, our International Glaucoma franchise as well as our Corneal Health franchise as we launch Epioxa and transition from Photrexa."

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Management indicated that further detail on 2026 guidance by franchise will be provided on the Q4 2025 earnings call.

FINANCIAL RESULTS

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The company reported "record third quarter consolidated net sales of $133.5 million."

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U.S. Glaucoma net sales reached $80.8 million, with iDose TR contributing approximately $40 million. International Glaucoma net sales were $29.4 million, and Corneal Health franchise net sales totaled $23.3 million, including Photrexa net sales of $20.3 million.

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Burns noted, "continued gross margin accretion" and strong liquidity with "$278 million in cash and no debt."

Q&A

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Thomas Stephan, Stifel: Asked about the CAC meeting and rationale. Joseph Gilliam, President & COO, responded, "we see this really as a step in the process of educating these MACs...the significant unmet need that iDose meets for glaucoma patients," and emphasized confidence in the data behind iDose.

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Stephan followed up on Epioxa pricing and 2026 Corneal Health expectations. Gilliam explained, "we'll engage in that process as we go through it. We're confident, obviously, that we be able to get a best-in-class solution that works well for the patients afflicted with keratoconus." Regarding 2026, he described the rollout of Epioxa as "crawl before we walk before we jog as we exit 2026."

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Adam Maeder, Piper Sandler: Sought more color on the 2026 revenue range and iDose performance. Gilliam said, "we feel confident in this early range and that a variety of paths through each of the franchises...will enable us to meet the expectations of that $600 million to $620 million range."

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Larry Biegelsen, Wells Fargo: Inquired about payer coverage for Epioxa and patient growth. Gilliam referenced the rare disease landscape and said, "as we move forward, the whole reason for what we're doing is to meaningfully expand that number."

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Ryan Zimmerman, BTIG: Asked about iDose ramp and inflection points. Gilliam indicated, "we've clearly established is plus or minus a pretty solid linear type launch in its early days."

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Joanne Wuensch, Citigroup: Questioned the 2026 guidance composition. Gilliam noted, "with the wholesale acquisition cost...implied in there is a material step-down in the number of patients being treated with Epioxa in 2026."

SENTIMENT ANALYSIS

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Analysts pressed for clarity on Epioxa pricing, payer coverage, and the sustainability of revenue growth, showing a neutral to slightly skeptical tone, especially on reimbursement and patient adoption hurdles.

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Management tone was confident during prepared remarks, emphasizing record performance, guidance raises, and product launches, but grew more cautious and explanatory in the Q&A, with phrases like "we're confident, obviously," and "our goal and our plan would be to provide more granular views."

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Compared to the previous quarter, both analysts and management were more focused on the revenue impact and reimbursement challenges of the Epioxa launch and the sustainability of iDose TR momentum.

QUARTER-OVER-QUARTER COMPARISON

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Guidance was raised more substantially this quarter, with a new preliminary 2026 revenue range of $600 million to $620 million, compared to last quarter’s focus on 2025 guidance.

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Epioxa's FDA approval and pricing strategy were major new developments. In contrast, the previous quarter focused on regulatory progress and pending approval.

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Analysts this quarter were more focused on the commercial potential and reimbursement of Epioxa, as well as the breakdown of guidance by franchise, versus prior quarter’s focus on iDose TR adoption and reimbursement progress.

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Management's confidence level remained high but shifted from operational execution to navigating payer coverage and patient access for Epioxa.

RISKS AND CONCERNS

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Management identified challenges in payer education and coverage for Epioxa, describing it as a "process where there's education at the payer level around the benefits associated with this therapy."

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Transition risks from Photrexa to Epioxa were acknowledged, with Gilliam stating, "we do expect to see a fairly material year-over-year decline" in Corneal Health as the transition occurs.

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Analysts expressed concerns about the high wholesale acquisition cost of Epioxa and potential headwinds in patient access and reimbursement.

FINAL TAKEAWAY

Glaukos Corporation delivered a record sales quarter and raised its 2025 revenue outlook, while introducing a new preliminary 2026 target driven by the commercial momentum of iDose TR and the anticipated launch of Epioxa for keratoconus. Management emphasized disciplined investment, robust pipeline advancement, and a comprehensive strategy to address patient access and payer coverage as the company transitions from Photrexa to Epioxa. The company remains focused on executing its growth initiatives and expanding its leadership in ophthalmology across multiple franchises and geographies.

Read the full Earnings Call Transcript [https://seekingalpha.com/symbol/gkos/earnings/transcripts]

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