Glaukos projects $1B 2027 revenue as it raises 2026 net sales guidance to $775M-$785M

• “Today, Glaukos reported record third quarter consolidated net sales of $211 million, up 58% versus the year ago quarter,” said (Chairman & CEO Thomas Burns), adding, “we are raising our full year 2026 net sales guidance to $775 million to $785 million.”

• Burns introduced a new forward marker, stating, “We are also introducing highly preliminary 2027 revenue guidance of $1 billion,” which he said reflects expectations for “the continued commercial rollout for Epioxa and iDose TR, the surgical MIGS landscape and our International Glaucoma franchise.”

• Burns highlighted profitability and cash generation metrics alongside investment intent: “Highlights included nearly 400 basis points of year-over-year non-GAAP gross margin expansion to approximately 88%… more than $50 million in cash generation, $28.5 million in non-GAAP net income and non-GAAP earnings per share of $0.47,” while also emphasizing, “our primary focus remains on maximizing near- and long-term revenue growth.”

• On Epioxa launch execution, Burns reported Corneal Health net sales of $59 million, “driven by Epioxa net sales of approximately $53 million,” and described access progress: “access pathways now established for approximately 90% of commercial lives… and more than 80% of Medicaid lives.”

• On iDose TR adoption and evidence, Burns said U.S. Glaucoma net sales were $118.6 million, “driven by growing contributions from iDose TR, which generated sales of approximately $76 million,” and cited Phase IV cataract-combination data: “an 11.1 millimeter mercury mean reduction in IOP… and a 3.6 millimeter mercury incrementally superior treatment effect at 3 months.”

• CFO margin commentary emphasized mix-driven sustainability: “we expected to see expansion in the gross margin as iDose -- both iDose and Epioxa… became a larger share of the mix… the third quarter being really, really strong at almost 88%,” said (Senior VP & CFO Alex Thurman).

Outlook

• Management’s raised 2026 revenue view centered on net sales guidance of $775 million to $785 million, alongside Burns’ preliminary 2027 revenue guide of $1 billion.

• On why the company guided 2027 early, (President & COO Joseph Gilliam) said, “we evaluated all the scenarios… including… downside scenarios with any iDose LCD… and… saw the path lead to $1 billion of revenue,” adding, “we thought it was prudent to provide an early look.”

• On iDose 2026 expectations, Gilliam said, “inside of our guidance implies… iDose, we expect to reach into the low 280s,” after previously communicating “$275 million to $280 million.”

• On Epioxa pricing assumptions, Gilliam stated, “assume in your models a $65,000 to $70,000 net ASP.”

Financial Results

• Burns tied Q3 operating model improvements to scale, citing “approximately 88%” non-GAAP gross margin, “more than $50 million in cash generation,” “$28.5 million in non-GAAP net income,” and “non-GAAP earnings per share of $0.47.”

• Segment results highlighted mix shift toward new platforms: Corneal Health net sales were $59 million (Epioxa approximately $53 million), U.S. Glaucoma net sales were $118.6 million (iDose TR approximately $76 million), and International Glaucoma net sales were $33.4 million.

• On expense trajectory, Thurman told analysts, “you can expect our operating expenses to continue to grow in the fourth quarter… 25% to 30%,” and said full-year 2026 operating expenses would be “plus or minus $630 million.”

Q&A

• Thomas Stephan, Stifel: asked how Epioxa and iDose “layer into the $1 billion” and why guide now; President Gilliam: “we'll hold off on doing that… as we enter next year,” but said the company “evaluated all the scenarios… including… downside scenarios with any iDose LCD… [and] felt confident that we could actually put that number out there.”

• Adam Maeder, Piper Sandler: asked for Epioxa launch metrics and payer/prior auth dynamics; President Gilliam: said the company exited Q3 with “more than 200 established sites of care” and “executed contracts… to greater than 300,” adding payer pathways were “90% of commercial lives and 80% of Medicaid lives,” while noting early-stage variability because “the time lines are varied payer by payer.”

• Larry Biegelsen, Wells Fargo: asked about returning to historical eye volumes and the “50,000 to 100,000” opportunity; President Gilliam: “I'll stop short of giving a time line prediction,” and said the estimate spans “fully progressive… to more mild disease.”

• Ryan Zimmerman, BTIG: asked about site-of-care strategy depth and margin durability; President Gilliam: said the launch is “methodical and targeted” because “you don't want to go too broad,” adding Glaukos has “north of 700” detection centers; CFO Thurman: “we wouldn't expect it to not be durable… given the fact that Epioxa and iDose continue to be” the key mix drivers.

• K. Gong, JPMorgan: asked about SG&A trajectory and inorganic vs organic investment; CFO Thurman: “operating expenses… fourth quarter… 25% to 30%”; CEO Burns: retina initiatives “exceeds $100 million in investment” per project and said, “we have the temerity to believe we're going to become a retinal company.”

• Mason Carrico, Stephens: asked about buy-and-bill penetration; President Gilliam: said buy-and-bill was expected to “lag” specialty pharmacy, but the buying-and-billing network has been “increasing rapidly… over the last 30 to 60 days.”

• Michael Sarcone, Jefferies: asked iDose trends and possible pull-forward from LCD risk; President Gilliam: cited Q3 iDose drivers from “fee-for-service… NGS” plus Medicare Advantage and commercial, and said Q4 pull-forward could be limited because “their surgery schedules are full.”

• Joanne Wuensch, Citi: asked when the LCD uncertainty ends; President Gilliam: said MACs’ “only statutory obligation… is 1 year from the date of their draft, which was May,” and a final LCD would have a “45-day” period before enactment.

• Richard Newitter, Truist: asked Epioxa ASP and whether the cataract-combination study can influence LCD decisions; President Gilliam: reiterated “$65,000 to $70,000 net ASP”; CEO Burns: said the cataract study served as “an insurance policy” and described plans to support potential “reconsideration request” if restrictions arise.

• Anthony Petrone, Mizuho: asked about prior authorization logjams and channel support; President Gilliam: said elongated timelines are “ordinary course… for all pharmaceutical launches,” and that efficiency improves “through volume,” supported by “our hub, EpioxaCareConnect… [and] our specialty pharmacy partner.”

Sentiment Analysis

• Analysts’ tone was positive and modeling-focused, repeatedly pressing on 2027 visibility, Epioxa launch mechanics, and LCD risk, including questions framed around “confidence” and “how should we think about” scenarios.

• Management’s tone was confident in top-line trajectory but cautious on specifics where the company withheld granular 2027 franchise layering; Gilliam emphasized scenario work, while LCD commentary was watchful: “we don't have any new updates to share.”

• Versus the prior quarter, Q3 introduced more explicit forward-looking framing (a $1 billion 2027 marker), while analyst focus remained concentrated on Epioxa access mechanics and iDose LCD outcomes.

Quarter-over-quarter Comparison

• Guidance shifted upward again: Q2 raised 2026 net sales guidance to $680 million to $700 million, while Q3 raised it to $775 million to $785 million and added “highly preliminary 2027 revenue guidance of $1 billion.”

• Epioxa commercialization discussion moved from early launch footing in Q2 (Epioxa net sales approximately $11 million and J-code becoming effective) to Q3’s first quarter with the permanent J-code in place and Epioxa net sales of approximately $53 million, with management emphasizing pathway coverage percentages and site-of-care scaling.

• The iDose LCD remained a central investor concern in both quarters; in Q3 management emphasized scenario planning behind the $1 billion marker and described procedural constraints limiting near-term pull-forward.

Risks and Concerns

• Reimbursement policy risk remained centered on iDose TR LCD uncertainty; President Gilliam said MACs have a “1 year” obligation window from the May draft and indicated the company is “preparing for a variety of potential outcomes.”

• Epioxa access friction risk was described as operational and payer-driven; Gilliam said early-stage variability is expected because “the processes associated with them are varied payer by payer,” and prior authorizations can be “elongated.”

• Scaling risk was flagged in operations and field support as Epioxa demand accelerated; Gilliam said site-of-care expansion “put pressure on our operations and our field support teams.”

Final Takeaway

Glaukos management framed Q3 as a scale inflection, pairing record $211 million net sales with a higher 2026 net sales outlook of $775 million to $785 million and a new, “highly preliminary” $1 billion 2027 revenue marker that management said was stress-tested against multiple LCD downside scenarios. The call’s investment focus centered on execution signals behind Epioxa (coverage breadth, sites of care, and prior-auth workflow maturation) and iDose TR (continued adoption plus incremental clinical evidence), while management reiterated that operating leverage and gross margin mix benefits are expected to persist as Epioxa and iDose become a larger share of revenue.

Read the full Earnings Call Transcript

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