GKOS — Glaukos Corporation

Summary of Glaukos (GKOS) Q4 2025 Earnings Call

1. Key Financial Results and Metrics

• Q4 2025 Net Sales: $143.1 million, a 36% increase year-over-year (34% on a constant currency basis).
• Full Year 2025 Net Sales: $507.4 million, up 32% from 2024.
• U.S. Glaucoma Franchise Sales: $86.4 million in Q4, a 53% increase, driven by iDose TR, which generated approximately $45 million.
• International Glaucoma Franchise Sales: $32.8 million, an 18% increase.
• Corneal Health Franchise Sales: $24 million, a 12% increase, with Photrexa contributing $21.4 million.
• 2026 Net Sales Guidance: $600 million to $620 million, implying over 20% growth at the midpoint.

2. Strategic Updates and Business Highlights

• iDose TR: Continued strong adoption with positive clinical outcomes. FDA approval for unlimited re-administration enhances treatment flexibility.
• Epioxa Launch: FDA-approved for keratoconus, with initial commercial launch plans underway. Focus on increasing patient awareness and access.
• Operational Milestones: Surpassed 1,000 employees, broke ground on a new facility in Huntsville, Alabama, and established a site of care network covering nearly 50% of the U.S. population.
• R&D Investment: Over $1 billion invested since inception, with ongoing clinical trials across multiple platforms.

3. Forward Guidance and Outlook

• 2026 Expectations:
  • U.S. glaucoma sales expected to grow by approximately 30%, primarily driven by iDose TR.
  • International glaucoma sales anticipated to grow in the high single digits, facing competitive headwinds.
  • Corneal health expected to grow modestly, with volatility anticipated around the Epioxa launch.
• Quarterly Dynamics: Anticipated sequential growth in iDose TR throughout 2026, with a stronger second half for Epioxa post-J-code implementation.

4. Bad News, Challenges, or Points of Concern

• Competitive Pressures: Anticipated headwinds from new competitive products in international markets, particularly affecting growth rates.
• Transition from Photrexa to Epioxa: Initial adoption may be slow due to the transition period and the need for prior authorizations, which could impact early revenue.
• Flat Growth in Non-iDose Business: The iStent franchise is expected to remain flat year-over-year as resources are focused on iDose TR.
• Market Access Challenges: Initial patient access may be gated by the site of care network and payer adoption hurdles.

5. Notable Q&A Insights

• Epioxa Coverage: Positive early payer communications noted, with no significant pushback on pricing yet. Coverage determinations are still developing as the drug enters the market.
• iDose Utilization: Surgeons are beginning to adopt iDose for standalone cases, with expectations for growth in this area as awareness increases.
• Operational Expenses: Operating expenses are expected to grow in the mid-teens percentage-wise in 2026, with a focus on balancing capital investments against revenues to achieve cash flow breakeven.
• Surgeon Training: Training efforts for iDose are strong, but the focus remains on optimizing reimbursement and access rather than solely on training numbers.
• Future Growth: There is optimism about 2027 exceeding 2026 growth due to the momentum from Epioxa and iDose, although specific guidance for 2027 was not provided.

This summary encapsulates the key points from Glaukos' Q4 2025 earnings call, highlighting financial performance, strategic initiatives, future outlook, and challenges faced by the company.