Glaukos Corporation (GKOS) Q4 2025 Earnings Call Transcript
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Overview
The earnings call indicates strong financial performance with 12% YoY growth in Corneal Health sales and raised revenue guidance for 2025 and 2026. The launch of Epioxa and infrastructure expansion are positive indicators. The Q&A reveals no payer pushback on pricing and expected sequential growth in iDose revenue. However, the lack of clarity on certain metrics and operating expense growth are minor concerns. Overall, the positive elements outweigh the negatives, suggesting a positive stock reaction.
Key Financial Performance
Fourth Quarter Consolidated Net Sales $143.1 million, up 36% on a reported basis and 34% on a constant currency basis year-over-year. The increase reflects strong global execution and the strength of differentiated technology platforms.
Full Year 2025 Consolidated Net Sales $507.4 million, up 32% year-over-year. The growth was driven by strong global execution and advancements in key commercial and development initiatives.
U.S. Glaucoma Franchise Fourth Quarter Net Sales $86.4 million, up 53% year-over-year. Growth was driven by contributions from iDose TR, which generated approximately $45 million in sales during the quarter, reflecting strong physician adoption and positive clinical outcomes.
iDose TR Full Year 2025 Sales Approximately $136 million. Growth reflects strong physician adoption and the compelling patient impact of the therapy.
International Glaucoma Franchise Fourth Quarter Net Sales $32.8 million, up 18% on a reported basis and 13% on a constant currency basis year-over-year. Growth was broad-based, supported by scaling international infrastructure and driving MIGS as the standard of care.
Corneal Health Franchise Fourth Quarter Net Sales $24 million, up 12% year-over-year. Photrexa contributed $21.4 million to this growth.
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Operating Highlights
iDose TR: Generated $45 million in Q4 sales and $136 million in 2025. Positive clinical outcomes and strong physician adoption. FDA approved NDA labeling supplement for unlimited re-administration in patients with healthy corneas.
Epioxa: FDA-approved for keratoconus treatment. Novel topical drug therapy that does not require corneal epithelium removal. Commercial launch planned for later this quarter. Early positive coverage determinations and payer engagement covering 50% of U.S. population.
U.S. glaucoma franchise: Record Q4 net sales of $86.4 million, up 53% YoY. Strong growth driven by iDose TR.
International glaucoma franchise: Net sales of $32.8 million, up 18% YoY. Growth driven by scaling international infrastructure and iStent infinite launch in Europe.
New facility: Broke ground on a new facility in Huntsville, Alabama.
R&D investment: Over $1 billion invested in R&D since inception. Advancing a robust pipeline across five therapeutic platforms.
Strategic growth drivers: Focus on iDose TR and Epioxa as transformational growth drivers. Expanding patient access and advancing treatment standards.
Market access and awareness: Significant investments in patient awareness, education, and access for Epioxa. Developing a KC screening tool and launching new marketing campaigns.
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Risk or Challenges
New Competitive Product Trialing Headwinds: The company expects new competitive product trialing headwinds in some major international markets as they progress through 2026. This could impact their international glaucoma franchise.
Payer Adoption Hurdles for Epioxa: Initial patient access to Epioxa will be gated by site of care network deployment and typical payer adoption headwinds and hurdles. This could delay widespread adoption and revenue generation.
Reimbursement Challenges for Epioxa: Epioxa will initially be available under a new technology miscellaneous J-code until a permanent J-code becomes effective in July 2026. This could lead to measured adoption during the interim period.
Economic and Currency Fluctuations: The company acknowledges the impact of general macroeconomic conditions, including foreign currency fluctuations, on its business and operations.
Regulatory and Approval Risks: The company faces risks related to regulatory strategies and product approvals, which could impact their ability to bring new products to market or expand existing ones.
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Guidance & Outlook
2026 Net Sales Guidance: Reaffirmed full year 2026 net sales guidance range of $600 million to $620 million, implying over 20% year-over-year growth at the midpoint.
iDose TR Growth: Significant value expected to be unlocked as market access expands and adoption increases in 2026 and beyond. Early in adoption curve with growing clinical interest.
Epioxa Launch: Epioxa drug availability expected later this quarter. Investments in patient awareness, education, and access to expand treatment for keratoconus. Initial patient access will be limited by site of care network deployment and payer adoption hurdles. Permanent J-code expected by July 2026.
International Glaucoma Franchise: Anticipates new competitive product trialing headwinds in major international markets through 2026, partially offset by contributions from iStent infinite.
Pipeline Developments: Advancing multiple clinical programs, including Phase IIb/III for iDose TREX, Phase IIIb for iDose TRIO, and Phase III for third-gen iLink therapy. Plans to bring a KC screening tool to market later this year.
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Shareholder Return Plan
The selected topic was not discussed during the call.
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Key Q&A
Q:Can you elaborate on the key highlights of early positive coverage determinations for Epioxa and any payer pushback on pricing?
A:Joseph Gilliam explained that early positive outcomes were observed with Medicaid societies and a large blue plan. Conversations have been clinical, with no formal or informal pushback on pricing. The company is looking forward to engaging payers on a claim-by-claim basis as the drug officially launches.
Q:What drove the sequential deceleration in iDose revenue in Q4, and what is the outlook for Q1 and beyond?
A:Joseph Gilliam noted a mix shift towards Medicare Advantage in Q4 and some rep incentive dynamics that pulled sales into Q3. Despite seasonally low procedure volumes in Q1, sequential growth is expected, with continued improvement each quarter through 2026.
Q:Can you break down the FY '26 guidance of $600 million to $620 million by business components?
A:Joseph Gilliam stated that international glaucoma is expected to grow high single digits, U.S. glaucoma to grow 30% year-over-year driven by iDose TR, and corneal health to grow modestly year-over-year. Epioxa's launch and transition from Photrexa will cause volatility, with stronger results expected in Q4.
Q:What is your reaction to the Street's Q1 revenue estimate of $132 million to $133 million?
A:Joseph Gilliam acknowledged the estimate and noted that Q1 will deviate from historical norms due to iDose launch and Epioxa transition. U.S. glaucoma is expected to be flat to Q4, corneal health to grow modestly year-over-year, and international glaucoma to grow high single to low double digits.
Q:How do you view the interplay between re-administration of iDose and TREX, and is there a cannibalistic effect?
A:Joseph Gilliam stated that re-administration and TREX provide multiple options for patients, with different algorithms depending on disease severity. The goal is to offer sustained pharmaceutical therapies for the duration of a patient's life, with re-administration becoming more material in the long term.
Q:What are your thoughts on operating expense growth in '26 and profitability?
A:Alex Thurman projected mid-teens year-over-year growth in operating expenses, reaching around $555 to $560 million in 2026. The company aims to balance investments in iDose and Epioxa launches with cash flow breakeven and operating leverage.
Q:How quickly do you expect to upgrade accounts to the new capital equipment for Epioxa, and when will Photrexa be phased out?
A:Joseph Gilliam mentioned that capital equipment installation is well underway, covering over 50% of U.S. lives. Photrexa will remain available through July 1, with a full transition to Epioxa expected in Q3.
Q:What is the expected impact of the repeat dosing label for iDose on new starts and re-administration?
A:Joseph Gilliam noted that re-administration is already happening and is expected to grow over time. The repeat dosing label provides confidence to surgeons and patients, potentially increasing new starts and long-term treatment options.
Q:What are the challenges and expectations for Epioxa's payer coverage and patient access?
A:Joseph Gilliam explained that early payer engagement has been positive, with clinical conversations covering over 50% of lives. The focus is on ensuring patient access through prior authorizations and appeals, with optimization expected as the J-code is established.
Q:What is the outlook for iDose utilization in commercial and Medicare Advantage patients?
A:Joseph Gilliam highlighted efforts to expand utilization in commercial and Medicare Advantage patients, including payer access, process optimization, and patient economics. The company is seeing encouraging signs on a provider-by-provider basis.
Q:What are the expectations for international glaucoma growth in '26?
A:Joseph Gilliam expects high single-digit growth, with competitive headwinds offset by iStent infinite launches and market access initiatives. Growth will be higher in early '26, moderating in the second half as currency tailwinds wear off.
Q:What is the progress on surgeon training for iDose?
A:Joseph Gilliam stated that surgeon training is not a limiting factor, as most surgeons are already angle-trained. The focus is on addressing office administrative and reimbursement dynamics to drive adoption.
Q:Review of Unclear Management Responses
A:Management avoided providing specific numbers for the expected re-administration rates of iDose and the exact number of sites equipped for Epioxa procedures. They also did not detail the exact timeline for achieving payer coverage policies for Epioxa or the specific impact of competitive dynamics on international glaucoma growth.
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Earnings Word Cloud
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GKOS Transcript
Glaukos Corporation (GKOS) Q4 2025 Earnings Call Transcript
Positive2-17
The earnings call indicates strong financial performance with 12% YoY growth in Corneal Health sales and raised revenue guidance for 2025 and 2026. The launch of Epioxa and infrastructure expansion are positive indicators. The Q&A reveals no payer pushback on pricing and expected sequential growth in iDose revenue. However, the lack of clarity on certain metrics and operating expense growth are minor concerns. Overall, the positive elements outweigh the negatives, suggesting a positive stock reaction.
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