Glaukos (GKOS) Piper Sandler 36th Annual Healthcare Conference summary

Product performance and market adoption

• iDose has seen strong sequential revenue growth, with a near doubling in Q3 and continued material progress expected in Q4.

• Training and onboarding for iDose are progressing well, with the main challenge being office staff and reimbursement processes rather than physician training.

• The majority of angle-based surgeons are familiar with the procedure, and the company has invested in field support to streamline adoption.

• Pricing for iDose remains healthy, with minimal rebates, but government discounts and copay assistance programs impact net ASP.

• iDose is expected to become accretive to corporate gross margins in the near term as volumes increase and manufacturing scale is achieved.

Reimbursement and coverage dynamics

• Systematic reimbursement for iDose is progressing, with most major MACs moving toward automated adjudication for drug and facility fees.

• Professional fee reimbursement lags but is targeted to be fully resolved in the first half of next year, enabling higher procedure volumes.

• Medicare fee-for-service patients face little to no out-of-pocket costs, while commercial and Medicare Advantage patients have more complex coverage and copay dynamics.

• Copay assistance programs are in place for commercial patients, offsetting ASP but supporting volume growth.

• Coverage for iDose is comparable to established products like Durysta, benefiting from existing payer policies.

Competitive landscape and international outlook

• International business faces headwinds from new competition, particularly Alcon's Hydrus, and FX volatility.

• Bundling glaucoma products with cataract products is complex, but competitive pressure is expected in key markets.

• New product launches, such as iStent infinite, are anticipated in select international markets, with timing dependent on regulatory approvals.

• iDose has potential for selective international expansion, with market entry decisions based on reimbursement and future product generations.