Mike, are we live? Good. Okay. Good morning, everyone. I'm Larry Biegelsen, the Medical Device Analyst at Wells Fargo, and it is my pleasure to host this fireside chat with the management team from Glaukos. With us, we have Joe Gilliam, the President and Chief Operating Officer, Alex Thurman, the CFO, and Chris Lewis, Vice President of Investor Relations. If anybody has a question they want to ask, just raise your hand. We'll call on you. Joe and Alex and Chris, thanks so much for being here.
Thanks for having us, Larry.
Thanks for having us.
Appreciate it.
Always been supporters of our conference, so I appreciate it.
It's a great conference. A lot of great investors attend, so appreciate it.
Our pleasure. So let's start with the big picture question, Joe. You've posted four straight quarters of 20% + growth, which accelerated in the second quarter, 29% constant currency. Talk about where you are as a company today and how you see the next few years at Glaukos, and do you see yourself as a 20%+ grower?
Yeah, sure. I think, obviously, you don't get to this stage from a growth perspective at increasing scale without a decade or two, in our case, of prolonged investment in our pipeline. And I think we've been talking about this for some time. I think back to even the initial public offering back in 2015, we were talking in large part about this moment, right? We continue to invest in changing the standard of care within combination cataract glaucoma surgery, but now we're finally at the place where we're able to start unlocking that much larger standalone glaucoma opportunity alongside of, obviously, the things we're doing in keratoconus and the like.
So when you put those together, I think we're set up quite nicely for a period or a prolonged period of above-market growth, and 20% + is certainly achievable, I think, for the years to come as we continue to unlock that much larger market opportunity. I mean, just think about it, Larry. I mean, at a baseline, we spent the last decade operating in a market that was measured more like 500,000 potential procedures in the U.S., and today we're looking at a market on glaucoma alone of 21 million-22 million eyes, of which 12 million-13 million are diagnosed and treated. So I think we continue to make investments today that are really about unlocking that much larger opportunity over the next decade.
So that's super helpful. Maybe just ask one follow-up on profitability. It's been, frankly, a lower priority for the company. I think as you've been going through this growth period and launch of iDose TR, when does it become more of a focus?
It's a great question, Larry. I mean, I think we'll continue to say that we have a large and rich pipeline that we're very excited about, and we've got some, obviously, a lot of programs and things that we're doing on the commercial side that are going to cause us to continue to invest. I think the near-term focus of the company for now and in the near future will be around cash flow break-even and generating cash and not necessarily profitability. That being said, we'll just have to see how iDose TR grows and how Epioxa grows, and we'll get to a point where profitability will come into play, but we'll let you know when we're going to twist that focus from a company standpoint to profitability.
And I think we've tried to be transparent with investors, with you all, obviously, as analysts, that our priorities, as Alex noted, are around driving growth. And so when we're sitting around the table as a management team, we're focused on making sure that we're making the right investments within reason to continue to drive as fast and hard of growth as we possibly can in that much larger market opportunity. And you combine that with, as Alex noted, a pretty significant pipeline, and I think even if we start to turn periods where we have a little bit more profit or cash flow, we're still a little ways away from where you'll see that as a central talking point of ours because we want to make sure we preserve the flexibility to continue in any given quarter to make the investments we need to to move the business forward.
That's helpful. Okay. So let's transition to iDose TR. You disclosed $31 million in sales in the second quarter. That was up about $10 million sequentially by our math. Talk about how the launch has, and it was a strong result relative to, I think, consensus. Talk about how the launch has progressed thus far and how we should think about the ramp in the second half, please.
Yeah, sure. I mean, I think we're still in the early innings. As you know, there's a fundamental foundation that has to be in place for you to really be able to do the fun things in terms of market development, and that really comes back to market access and reimbursement, and we've been, I think, transparent about where we're at on that. The results that you speak of, as I said on the second quarter call, were 80% driven in the context of iDose TR by really Noridian and Novitas, which represent about 50% of the Medicare lives. So when you start to stack on top of that, obviously, now NGS and hopefully the other MACs turning along behind them, as well as that larger opportunity around commercial Medicare Advantage, you get pretty excited about, obviously, where this can all go.
We have to continue to stage gate as we think about the relative near term, which, as you're describing, the third and the fourth quarter. Third quarter, you have to think about some of the seasonality. We said we still expect to grow, but it'll be a little bit of a different trending, if you will, because of the summer seasonality, and then obviously hoping to exit the year on a strong trajectory going into 2026.
That's helpful. Okay. So Street's up $3 million sequentially in Q3, $9 million, I think, sequentially in Q4. That seems like a reasonable kind of cadence to you?
I wouldn't get that granular in terms of endorsement. Obviously, on the individual line item, we obviously gave our overall guidance and the directional commentary. There are a variety of things there, obviously, iDose being the most important one, how the stent business continues to transition through the LCD impact, and then, of course, in the fourth quarter, the corneal health dynamics around what we hope will be an Epioxa approval and the transition from Photrexa to Epioxa. But I think in general, when we look back after the second quarter, the street landed in a pretty good spot in terms of our overall business for the remainder of the year.
Okay. Thank you. And then on the MACs, so NGS just posted the professional fee. I think that was a pretty good number.
Yeah.
So you talked about Novitas and Noridian. You have NGS.
First Coast.
First Coast.
Correct.
So, you're waiting? There's two or three others?
Three. The two larger, which are Palmetto, which is largely in the Southeast, and WPS, which is in the Central Midwest, and then CGS, which is the smallest MAC, which is really Ohio and Kentucky. And I think we're continuing to make progress with all of them. I mean, I think as you go through this process, what they do is it's largely a process for them of education. They look at claims data to understand because then they're going to try to price that code. And now that you've had the three largest go through that process and by extension a sister MAC in First Coast, you can really start to have a more direct conversation with the remaining MACs around the efforts that have been undertaken in the other parts of the country and where they landed and why they landed the price points they did.
And so we start to increase our advocacy and efforts associated with that. And so hopefully we'll get some progress there as we exit the year.
How big is NGS and when can we start to see an impact?
NGS is the third largest, just slightly smaller than Noridian. For round numbers, call it sort of high teens to 20% type of the fee-for-service lives in the U.S. I think with all we've seen with Noridian and Novitas so far, there tends to be a little bit of a lag effect, and that's simply because you have the milestone. They've actually got to get it in their systems that way. Your sales force has to have that conversation, obviously, with customers or your reimbursement teams. Then those customers have to see it for themselves. Then as they start to schedule, many of these doctors, as you know, Larry, are scheduled out two, three, four, five months, and so you can see that lag effect and how that plays out in terms of really that pull-through.
But I think we'll start to see the benefit of it in the fourth quarter from NGS and then probably more meaningfully as we go into 2026.
How are you addressing the remaining friction, those three that haven't come online?
Yeah. And I sort of alluded to this earlier. It's really an exercise of kind of I'll call it dialing up the conversation. At first, you're very much in education mode. You want to make sure that you're letting them know the procedure, what goes on with the procedure, the time associated with that procedure. But as these other larger MACs start to actually do their work and price those codes and have that out there, you start to turn a little bit more to advocacy alongside of that education, doctor, provider, society type advocacy to try to get these remaining MACs over the hump, if you will. And we're in full swing on that effort.
Okay. That's helpful. When do you expect commercial payers to come on board?
In large part, actually, they already are. So just to be clear, underneath all of this, a little over 50% of the commercially covered lives, as well as Medicare Advantage covered lives, are already in policy. So one of the benefits, obviously, of having Durysta get approved, obviously a very different treatment modality, but get approved before us is that for the payers, they largely put iDose TR where they had a policy, they dropped iDose TR into that existing policy. So we have good coverage. And quite frankly, even beyond that, which is normally the case, there's only a handful of payers who have a negative coverage determination. So 98%-99% of lives actually are in play. The adoption is the element there that's, I think, the more relevant one. It's not about the payer policies or access.
And for that, it's account by account getting them up to speed. And you can't really do that until they've gotten the fee-for-service game. So once an account and a physician is comfortable with the procedure, confident in the reimbursement on the Medicare side, then you start to build on that by walking, if you will, and then jogging on the broader patient population of commercial Medicare Advantage. And we're in those early days now. So we're starting to follow in Noridian and Novitas, where you have some of the doctors. You'll start to see increasing volumes coming out of them that are associated with the commercial Medicare lives.
You already have a copay assistance program?
We have copay assistance program. We have specialty pharmacy. We have the hub up and running. We have our policy library. We have all the tools that are there, so it's more about field execution of that and continue to iron out, obviously, all the normal kinks that happened in the early days of any one of those launches.
So Joe, you know that the peak sales are as important, if not more important, for investors as the kind of ramp. Okay. Both are obviously important. You have not given any kind of peak sales or anything like that. We ask about analogs. SLT probably is the best one I can think of. There's different numbers out there, 500 to a million, 500,000 to a million. I don't know what your data says. Market Scope's kind of changed a little bit. Is there an analog out there that you think is a good one for us to think about?
Yeah, and I think, let me first say, we recognize the importance of what you just stated around that long-term opportunity. We intentionally view there's a time and a place for that conversation. I think sometimes companies get out a little bit ahead of themselves and overselling what they believe that to be before you really know the product profile and the adoption curve and the things that are there. And we know that over the past year of the launch, no matter what we said the long-term opportunity was going to be, folks are going to be focused on the MACs and kind of the next quarter or some of those more shorter-term dynamics. But as we look out, there'll be an appropriate place for us to have a conversation, I think, about the longer-term opportunity.
I will say this: we've only gotten more bullish internally around what we think we can accomplish over that five and 10-year period of time. And the reason for that, which I think is most important, is the product that's performing. So whenever you go through a clinical trial, you hold your breath a little bit when you first launch a product commercially. Now that we're at this stage, we see the results and the impact it's having in these surgeons' hands, and it's performing as advertised, which gives you that much more confidence around how this ultimately plays in that larger market opportunity. You referenced, I think, the building blocks, right? So what do investors have to believe or what do we have to believe in the context of getting there?
And there are certain analogs associated with whether it's post-Durysta utilization, SLT utilization as already patients who are going into the interventional glaucoma treatment paradigm that you don't have to convince. You're not really changing the standard of care within that. You're just simply going after that. And so whether it's the 500,000 of these more conservative end, you tend to see numbers that are like 900,000 to a million SLTs done a year. I think ultimately the majority of those patients become good candidates at some point in their life cycle for an iDose TR procedure.
From a big picture standpoint, I think probably the best analog is to look at a combination MIGS and the way that happened within that 500,000 patient market, how that adopted over time, how we changed behavior, the adoption curve of surgeons to be willing to do that, and ultimately establishing that standard of care over a ten-year period of time, and then kind of match that against what we saw from the retina world. If you think about if you go back and look, the best analog you can see within certainly ophthalmology in our case is the change of standard of care that happened when the anti-VEGF products, first Lucentis really, and then ultimately Eylea and the like, changed the behavior of an entire industry segment. Those surgeons that were in retina prior were largely relegated to late-stage, heavily invasive procedures.
And over the course of a 10- 15 year- period of time, that's obviously completely been changed by the invention and then ultimately the utilization of anti-VEGF proteins. And I think we're in a similar place in terms of glaucoma care where historically glaucoma specialists did very difficult, hard procedures, and now we're taking a much more minimally invasive approach to being interventional in the way that we manage the disease. And that'll take the same 10- 15 year- period of time to ultimately realize that peak, but I think we're well on our way.
But if I think about SLT and the Anti-VEGF, they benefit from repeat procedures, SLT, a lot of patients getting multiple. And if I think about Anti-VEGF, I think they're done in office. So you're pursuing both. So my question is, how I think it's important to unlock both of those to reach higher peak eye dose sales. Do you agree? And where are you in the process of each?
Yeah. I think we've been consistent from the beginning of saying our goal is to be site-of-care agnostic. Our goal with the product itself and the way we approach it is to meet the surgeons or the practices where they're at. There are some for a variety of reasons who prefer to do their procedures in a hospital. You'll have it in the hospital setting. Obviously, there's a lot more who prefer today to be doing it in the surgery center, whether because of ownership or other reasons as they do that. And then ultimately for us, then that next level is turning it on in the in-office. You'll remember that in the actual iDose pivotal studies, we had a cohort of patients who were done in the in-office setting. So we've been through that process. We talk about the next generation of injector systems.
We've talked about the process we'll undergo with the MACs to turn on the right in-office coding. So that'll be a journey that we'll be on over the next couple of years to start unlocking that in an increasing fashion. But there's nothing that really holds back the actual procedure. It's more about just continuing to optimize both the injector system as well as turning on that coding as a part of that process. And I think we've said this in prior calls and conversations. You have to really have the whole coding landscape, if you will, and coverage so that they're paying the drug, they're paying the facility, and they're paying the professional fee established. Then you can go do the calculations around what would be an appropriate in-office economic package and have those conversations directly with the MACs. And that's something that we're well underway with.
It's a 26 event?
I hope so, but it's a little bit too early to say. We're in the process of you think about the timing of some of these policies, Noridian and Novitas being the ones that you would focus on, and so you kind of engage in that, and then ultimately when they turn on those codes is a little bit at their discretion, so our job will be to continue to sort of advocate for that and educate them to a place where they'll turn on those codes.
The reimplantation, we know where you are in that, the PDUFA date in January.
Exactly.
TREX if that's the plan B.
Exactly. And I think in general, remember whether it's commercial plans or even Medicare, there's still a degree in which doctors can do what they believe is clinically best. So labels are one thing and certainly impact how we can market and promote and do all those type of things. But doctors still have the discretion. If I was in a situation where I had a patient who was doing really well on iDose, I'm probably going to advocate and fight to try to continue that access and coverage irrespective of what the label will or won't say. But yeah, we've got the PDUFA coming in January. We'll go through that process and hopefully we turn over that river card and that becomes one less thing you can ask about, Larry.
I hope so. I hope so. Hey, I wanted to switch gears on Epioxa. I'm more interested in kind of how you frame the opportunity, the upside opportunity as opposed to kind of this short-term disruption you've talked about. You're obviously going to charge a price premium. My guess is it's probably a pretty significant price premium, not the usual 10%, 20%. Then so what type how should we think about framing the opportunity at Epioxa. You also have a capital, a potential capital upgrade. How would you frame the upside opportunity beyond the initial disruption?
First, I think on the capital side, I would dissuade you of putting much benefit from that because there's not a lot of motivation. We want to get the capital equipment in place so that patients can get access to the therapy, and so that will be a more minor part of the overall, I'll call it transition side on the pricing element.
You would just replace the cap that you're not going to. There's not going to be a capital equipment upgrade?
There will be a capital equipment upgrade, but our motivation is not to maximize the revenue associated with that capital equipment upgrade. There's rules obviously associated with what you can do. But from our standpoint, we want to make sure that we establish our site of care network as rapidly as possible. And you don't want capital to be an impediment to that cycle. And so you don't want price of capital to be an impediment to that cycle, obviously again, subject to compliance rules and things like that. When you think about the drug pricing, we've been on the record as saying obviously it's a significant advancement in the standard of care for patients and practitioners. And so we would expect a price premium. And we haven't really talked in any more detail, largely because obviously there's a ton of work that goes behind that.
We'll communicate that at the right time and the right place to investors and our customers. I think the big thing around the long term, again, we'll go through the transitory dynamics that are normal. There's going to be both in terms of patients wanting Epioxa and that disrupting in terms of the volumes. Then the normal commercial payer dynamics around how they adopt drugs, even in established standard of care categories, they're going to have NDC blocks. You're going to have a variety of things that will slow the volume-related path forward in 2026 even that will work through. The big thing here is establishing ourselves in a place where we can actually make the right investments to drive patient awareness, diagnosis, detection, and ultimately treatment.
Whenever you're dealing in a category, and I don't know what you have in your model, Larry, but where you're talking about single thousands to tens of thousands of patients or eyes in our case, you simply have an awareness and detection issue. There's 50,000 optometrists out there. So if you think about that math, if you're doing make it up, 10,000 patients, they're simply not waking up in the morning and going to bed at night thinking about the detection of keratoconus. And so that requires a little bit different approach from us as we move forward with this new therapy to driving that behavior. It requires a little bit more on the direct-to-patient side. It requires a little bit more on how we get to those 50,000 optometrists and make sure they're capturing and then referring to the treatment centers.
And so I think from our standpoint, the combination of a therapy that is far more friendly to the patient from a procedural standpoint alongside those efforts, we hope that a lot more patients are found and treated even prophylactically because the drug works, right? It arrests a sight-threatening disease. And so it's on us to make sure as many of these patients are found and ultimately treated.
So it's going to expand the market and there's obviously an ASP uplift, but you're not going to quantify that.
Yeah. I mean, we will eventually, but we're not going to quantify right now. And I think wherever we land, it's important for investors to remember that it will come at headwinds to volumes over a period of time. And we'll get more granular obviously on that as we get more into the launch curve. But it's not as simple as taking kind of current volumes and saying, "Hey, here's what the price is and this is what we think the 2026 revenues will be.
What's the headwind besides patient warehousing?
The primary headwind in 2026 will be normal commercial payer dynamics. So whenever you launch a new drug, irrespective of even price really, payers adopt those at different ways and different times. And so some will just simply blanketly put NDC blocks in. So they block drugs until they've gotten enough information to feel that they want to include it in the policy or start to open up access. Others update their information once a quarter, every half a year, sometimes once a year, depending upon how they go about it. And so you really have to drive advocacy to ultimately get access to your drug. And we expect to do that in 2026. So there'll be a transition period. And remember, we'll start with a miscellaneous code just like we did with iDose. And then the J-code will turn on hopefully mid-year.
That's another important step as you kind of go through that overall process.
So this is going to be similar to what we experienced with iDose a little bit. Is it a new? It'll be a new J-code?
Yeah. I think it'll be, it's similar, but for different reasons. I mean, obviously in the case of iDose, you've got an older patient population. It's very dominated by Medicare in the context of dynamics. We've been talking about traditional Medicare. Whereas with Epioxa and cross-linking, you'll be dealing mostly with commercial payer patients because of the younger disease demographic as well as Medicaid.
That's helpful. Okay. Let's transition to the MIGS business. Two-part question. Kind of where are you in kind of the LCD headwinds and when do you expect that to kind of moderate or lap? And what's the durable growth rate for the MIGS franchise going forward?
Yeah. Two good questions. First, on where we're at, we've sort of said we think that it likely peaked in terms of its impact in the second quarter. And that's implied from the commentary we had around the second half. And that's driven by a couple of things. A little bit of its comparability to 2024. A little bit of the fact that the LCD actually came into place in November of last year. So you expect a little bit of that moderation of that headwind. And ultimately, we would expect to have largely lapped that headwind, if you will, as we enter into 2026. I mean, maybe there's still a little bit of that lagging into the first quarter when people are kind of changing their behavior. But in general, as you make your way into 2026, I think that you put that behind you.
One of the things that Alex has mentioned in a couple of calls is that in 2025, for those two MACs that did not adopt a similar LCD, we've actually continued to grow. So that tells you in the context of the dynamic as you sunset, if you will, and lap the LCD and the other MACs, the underlying market should be in a place where it's still able to grow and grow at least in sort of the low to mid-single digits range. I think the bigger question for Glaukos in that context as we sunset that or anniversary that is the iDose versus iStent dynamic. And I think for us as a company and certainly for you all as shareholders, the motivation is fairly high to get as many of those units into the iDose camp relative to MIGS.
And so I think if we were solely MIGS company, I'd be confident that we'd be back and growing whatever you want to call it, mid-single to maybe high single digits on the stent franchise next year. I think that as we think about it in terms of our relative priorities, there will definitely be a growth headwind that's simply associated with the competitive dynamics between iDose and those stents. And we'll always be motivated, obviously, to be putting iDose first and always and to a certain extent the stents where it's appropriate in that treatment algorithm. And it won't be as front and center for us. So I think we'll have to wait and see when we get into next year.
But don't expect us to sort of overpromise, if you will, in the context of the growth dynamics associated with that piece of the portfolio next year. I think it's going to be largely an iDose-driven growth story, obviously for the years to come, including in 2026.
What about competition in the MIGS business? I mean, obviously Bausch + Lomb has a product they acquired. Is there anything that you think could impact the growth in that business?
I think we, I mean, we respect all competition. In almost all of those cases, we've seen those products internationally in some way, shape, or form. So we understand where they fit in the treatment paradigm. I think that you have to zoom out for a second when you think about the competitive dynamics. That is we're no longer as an industry relegated to the 500,000 combo cataract eyes. So that's most important. Whether it's Bausch + Lomb, whether it's Alcon with their SLT introduction, whether it's other companies out there, I think at this point we're all rowing largely together in trying to tackle a much larger opportunity in changing the standard of care. It's less about market share dynamics today and much more about how do we grow and really unlock what is a significant opportunity for ophthalmology and the companies that operate within it.
I think we'll be in that place for many years to come. We talk about internally, the competition is not other technologies today. It's actually drops and the standard of care and shifting that to what we believe is better for patients and ultimately the industry as well.
The other two LCD MACs that did not adopt the LCD, is there a risk that they will?
Sure. There's always a risk. Anytime you're pioneering new categories and they develop policies and changes and things like that over time, there's always that risk that they could do that.
How big are those two?
It's Novitas and First Coast. Call it roughly high 20s of 30% of lives.
And it sounds like the CMS proposed rule for 2026 where kind of the physician fee went down is going down for stenting, but facility fee going up net in 2026. If those stay where they are, neutral?
Yeah, I think so. I mean, obviously from a facility standpoint, everything was largely in line with what you'd expect. On the professional fee side, it wasn't about stents MIGS. It was actually a broad CMS approach in a lot of disease categories, ophthalmology being one of them, and it hit across all of the major categories from cataract surgery and the like, and they just, they've taken a slightly different approach to how they're valuing some of the resource utilization there and the physician office component of all that, and so from our standpoint, obviously, we never see anything that's going to impact the economics that go to, often, the most disadvantaged part of the ecosystem, which is the healthcare providers themselves, so we'll advocate, obviously we have been, that CMS has taken the wrong approach on that.
In terms of its impact to us in volumes, I think it's a relative neutral, as you said, simply because all of the procedures were hit in a similar fashion. So there was really no change to the relative dynamics in terms of, I'll call it, economic-based motivation across different procedure types.
And I just wanted to go back to Epioxa for a second. Is the message, when I'm trying to think in my head of what you said about the transition, is the message that the 2027 is where you'll start to see kind of the benefit of Epioxa to the business maybe from a fully when will we start to see it sounds like you're signaling this disruption and this transition period. And I'm saying to myself, maybe corneal health in the US might be down in 2026 relative to 2025. Am I thinking about it right? And kind of when do you think that business starts to grow again?
Yeah. So I think, and obviously we'll dial this in a lot more in the context of guidance and all that kind of thing. But I think there's still a path to growth in the franchise in 2026. I don't think it'll come from volumes. I think it'll come from obviously the relative delta in price. And I think it'll be a sequential quarter in and quarter out continued unlocking of patient access that will methodically over the course of 2026 and however long it's hard to determine that we'll continue to see an opening of that market opportunity. And our job will be to try to drive that as fast as possible. But I don't think you're going to hit the ground running in 2026 for all those reasons.
So there is a problem on a year-to-year basis for corneal health in the U.S. to be higher in 2026 sales relative to 2025.
Yeah, I think so. I think that we'll, again, we'll dial that in in a lot more detail when you know all the sort of facts associated with that launch. But I do think we're going to go through a period where for patients, they're going to be asking themselves the question of, "How long can I fight for access to Epioxa with my insurer versus having to do Photrexa or some other option as they go through that process in 2026?" And we're going to do everything we can to make sure as many of those patients get access to the drug as possible.
For MIGS, are you going to continue to underpromise and overdeliver?
You always love to pick on me about the international, and I share that with our international leaders that you call that out. It's been. And I have to give credit where credit's due. Our team has continued to deliver in all of the regions above our expectations. We made a major push in international markets in 2017, 2018 timeframe, and so we're now seven, eight years into many of those launches, and the team is still very much in growth mode around unlocking both market access, but also patient adoption utilization, all those types of things in many of these markets, and so I think we'll continue. Obviously, scale starts to work against you in some respects. The competitive dynamics, we still continue to call out. Obviously, Hydrus in particular is entered into two of our largest markets in France and Japan.
And we have a lot of respect for Alcon and how they execute. So I think that will all be things that hold us back. But so far, so good in terms of our team's execution against those things.
So Joe, I know you've been chomping at the bit to answer the '26 question.
Have you already asked it like three times?
Maybe sum it up. I was wondering to just cut to the chase. Consensus, 26% growth, $618 million. And actually, Alex, it looks like consensus has positive EPS next year. It didn't sound like that's what we should expect. You're nodding your head for people on the webcast, but.
Yeah.
Well, so people know what the message is on EPS.
I mean, I think there are a variety of scenarios that could happen, and we'll dial that in when the time is right, I think.
Okay. It didn't sound like it was near-term based on your commentary there.
That would not be our focus for sure.
Okay. And Joe.
I think it's been clear. Our goal is to get back to cash flow break-even or pretty close, and that's, in some ways, you're singularly focused on that from that perspective.
What revenue have you said?
We haven't said that. In fact, we've had some periods where we've already achieved it. So we're in that kind of balancing act right now in any given quarter, I would say.
That's exactly right.
So, Joe, you have given a lot of 2026 color. Thank you for that. But when you sum it up and you see consensus, is there anything obviously, iDose continues to ramp. The Street's at, call it, 230, almost 80% growth next year. Any reaction to that? Anything that you've obviously, I'm sure you've looked at the components. Anything where you're seeing a mismatch that you want to highlight?
No. I mean, I'm not going to obviously get granular on the number or the various dynamics there at this point. But I will say, as we look at the transition next year, I think we've talked at length about some of the corneal health and Epioxa dynamics. We've talked, obviously, around the international continued transition there and their puts and takes around that. I think growth will continue to moderate there. But we have a great franchise internationally, and we're continuing to change the standard of care. And as it relates to the U.S. glaucoma, it rightfully comes a lot down to the iDose perspectives. And for that, I look forward to hopefully having a full year of running where you've got the MAC noise behind you, and you're really driving that adoption there for the full year.
And then the commercial overlay slowly coming on top of that as a part of driving that franchise. So I think that we're in a strong position as we make our way through the end of this year and head into next. And we just got to keep putting our head down and executing to drive as fast a growth as possible.
One quick follow-up on the iDose pro fee from the MACs. Any of those three that have not posted the professional fee? Do you expect any more this year?
Well, what I've said is I actually, that's hard to say. And as you get towards the end of the year, their calendars in which they do these things start to dry up. And so it may or may not. But what I can tell you and promise you is that our advocacy and communication levels are only dialing up. And with the largest MACs having acted, you certainly hope that you can make the case to put this behind you. At least in the case of Palmetto and WPS, CGS is a little bit more challenging given their size. But I'm hopeful that we're getting on the back end of that conversation.
All right. Well, appreciate you guys being here. Congrats on all the success. And good luck with the rest of the year.
Thanks, Larry.
Appreciate it. Thanks.
Thank you.