Conference Transcript - GKOS 2025-07-30

Operator

Welcome to Glauco's Corporation's Second Quarter 2025 Financial Results Conference Call. Copies of the company's press release and quarterly summary document, both issued after the market closed today, are available at www.glaucoast.com. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during that time, simply press star, then the number one on your telephone keypad. This call is being recorded and an archived replay will be available online in the Investor Relations section at www.glaucos.com. I will now turn the call over to Chris Lewis, Vice President of Investor Relations and Corporate Affairs.

Chris Lewis, Head of Investor Relations

Thank you and good afternoon.

Chris Lewis, Head of Investor Relations

Joining me today are Glacos Chairman and CEO Tom Burns, President and COO Joe Gilliam, and COO Alex Thurman. Similar to prior quarters, the company has posted a document on its Investor Relations website under the Financials and Filings Quarterly Results section titled Quarterly Summary. This document is designed to provide the investment community with a summarized and easily accessible reference document that details the key facts associated with the quarter, the state of the company's business objectives and strategies, and any forward statements or guidance we may make. This document is designed to be read by investors before the regularly scheduled quarterly conference call. As such, for this call, we will make brief prepared remarks and transition into a question and answer session. To ensure ample time and opportunity to address everyone's questions, we request that you limit yourself to one question and one follow-up. If you still have additional questions, you may get back into the queue. Please note that all statements, other than statements of historical facts made on this call, that address activities, events, or developments we expect, believe, or anticipate will or may occur in the future are forward-looking statements. These include statements about our plans, objectives, strategies, and prospects regarding, among other things, our sales, products, U.S. and international promote development efforts, product approvals, the efficacy of our current and future products, strategies and reimbursement for our products, as well as the expected economic conditions.

Tom Burns, CEO

or 29% on a constant currency basis. As a result of our strong performance, we are raising our full year 2025 net salary to $475 to $45 million previously. Our second quarter record results reflect a sustained growth acceleration in our business driven by growing IDOS-TR adoption and utilization, along with our broader interventional glaucoma, or IG, initiatives globally. While we are in the early stages of these IG efforts, our focus remains on driving new standalone intervention therapies designed to slow disease progression and reduce drug burden for the benefit of the physician. We continue to be encouraged with increasing levels of clinical interest. Within our U.S. glaucoma franchise, we delivered record second quarter net sales of study continuously delivered glaucoma drug therapy for up to three years, continuous feedback that reaffirms our view that with the launch of I-Dose TR, we have a therapeutic category that has the potential to reshape what's called a management as we know it today. Operationally, our teams continue to make great progress in the execution of our detailed launch plans for I-Dose TR, including, first, growing the universe of trained surgeons and accounts, second, expanding utilization of the installed active surgeon base, third, Third, broadening and streamlining market access among MACs, commercial, and Medicare-advantaged payers. Fourth, expanding the robust body of clinical evidence. And fifth, accelerating marketing investments to support increased patient awareness and education. Shifting to our U.S. spent business, as anticipated, the five MAC LCDs implemented in the fourth quarter of 2024 continued to cause some transient turbulence in the market during the second quarter as surgeons navigate restrictions when using two MAKS surgical devices in the same procedures. We expect this MAKS market headwind will continue over the course of 2025 as providers continue to navigate the impacts associated with these LCDs until at anniversaries later this year. As a reminder, our second quarter U.S. glaucoma results also reflect the expiration of royalty payments associated with the hydros in late April. Earlier this month, CMS issued its proposed rules for 2026, which, as drafted, largely maintained the 2025 APC assignments and modestly increased the social outpatient and, in contrast, some for several Category 1 CPT codes across ophthalmology, including for cataract and surgical mix procedures, primarily from a major revision in how CMS allergens are particularly impacting services. We tend to support our assumptions, so 3% on loop. This strong growth was once again broad-based as we continue to detail our international infrastructure and execute our plans to drive banks forward as a standard of care in each region and major market in the world. Last month, we were pleased to announce EU NPR clearance for ISTEN Infinite along with several of our other leading trabecular micro-bypass mix technologies. Of note, glaucoma in both combo cataract. These important milestones, which mark our company's long-awaited first approvals under the new EU regulatory framework, will not only help us maintain and grow our presence in Europe, but also advance and accelerate our broader IG initiatives globally. We plan to commence commercial launch activities for Einstein Infinite in our key European markets at the upcoming ESCRS annual meeting in September. As previously discussed, we continue to expect the trialing of new competitive products in some of our major international markets may become an increasing headwind as we progress through 2025. $6 million out of the year, including Fortrexan net sales of $17.9 million. As discussed previously, our second quarter results reflect the continued impact to Fortrexan realized revenues as a result of our entry as a company into the Medicaid Drug and Rebate Program, or NDRP. Shifting gears to our corneal health pipeline and FDA's ongoing NDA review for Epioxa, our next-generation corneal cross-blanking eye-linked therapy for the treatment of peritonis, a rarely diagnosed site-threatening disease, along with a productive post-mid-cycle review meeting with the agency as we continue to progress towards the established PDUFA date of October 20, 2025. Alongside this regulatory review, our commercial and market access teams continue to make solid progress in the preparation and planning of the Epioxide commercial launch targeted for next year. As a reminder, this potential approval would provide care to those patients in the Epthalvin community with the first FDA-approved, surgery-free, topical drug therapy that does not require the outermost layer of the front of the eye. An Epioxa approval would also provide us with the opportunity to launch this pharmaceutical therapy supported by the right long-term pillars to optimize patient access, a persistent and at times frustrating challenge. Because we believe Epioxa, which is designed to preserve the corneal epithelium, streamline the procedure, improve patient comfort, represents a potentially breakthrough treatment disruption, transitions from Fortrexel to the FBI. We send surgical glaucoma platform. We are advancing patient enrollment in a PMA pivotal trial within our IDOS platform. We are advancing the Phase 2B3 clinical program for IDOS T-Rex, our next-generation IDOS therapy with patient enrollment already underway, and now expect an FDA decision regarding re-administration for IDOS PR in early 2026. Within our ILUCI platform, in addition to the ongoing Epioxa-NDA review, we are also advancing phased ILUCI therapy. Within our ILUCION platform, we remain on track to file and commence a clinician Demodex bloodstream filing. Within our platform, we are advancing a first in human clinical development program for GLK and wet AMD patients, where we now also have a lot to be excited about when it comes to significant potential value that we believe our pipeline programs may create. At the same time, as we consistently discussed, we continue to prioritize the cadence of our investments both now and in the future. This disciplined approach has enabled us to stay with a focus on transactions that complement and enhance our existing organic growth initiatives. During the second quarter, we put this strategy to work with the small acquisition of Mobius Therapeutics, whose lead compound Midasol of Mitomycin to our deepening. We continue to invest operationally in support. Excluding these, in conclusion, I'm very pleased with another record quarter.

Operator

At this time, if you would like to ask a question, press star, send the number one on your telephone keypad. To withdraw your question, simply press star one again. We kindly ask that questions are limited to one-in-one follow-up for today's call. We will pause for just a moment to compile the Q&A roster. Your first question comes from Tom Steffen with Stiefel. Please go ahead. Great. Hey guys,

Tom Steffen, Analyst — Stifel

thanks for taking the questions. Nice quarter. One sort of near term just on 2025 sales guidance You beat Street and 2Q on revs by, I think, $8 million, $9 million. But on the guide, you only raised by $3 million at the midpoint. Tom, you made some comments on OUS glaucoma and corneal health within the guide. But, Tom or Joe, can you talk about the components of this year's revenue guide and then maybe why more of the upside wasn't flushed through for the full year?

Joe Gilliam, COO

Yeah, Tom, it's Joe, and if Tom wants to add something, he can. And obviously, you did the math pretty quickly there to raise guidance off the back of what was an exceptional second core performance across the board, but largely by Eidos in particular. And I think when you do it more, you'll find that really it was a full beat and raise in the context of Eidos, which is obviously the core of the growth story as we sit here today. But several data points, if you think about updating your models for the second half of the year, you know, first on the international glaucoma side. Obviously, we continue to be off the strong start this year. It has some currency benefits in the second quarter, and we're now expecting that you'll have sort of low double-digit growth for the remainder of the second half on a year-to-year basis. Largely unchanged there in terms of our expectations of our growing scale and competitive products launching in key markets that present headwinds as we move forward relative to the results. On the cornea side, you know, Tom, I think, elaborated on this, but I'll repeat it. You know, when we go into the second half here, we enter a period with, I'll call it, less visibility or predictability as we navigate the transition from potrexa to epioxida, assuming the latter is approved as expected in October. A material disruption or headwind in Q4 as patients forego potrexa in favor of epioxida for all the reasons that Tom articulated. in glaucoma side where, you know, we continue to expect the same dynamics around the LCD headwinds and the generation of probably a mid-single-digit decline for all called the non-high-dose revenues in the second half. And when you put all that together, it's going to imply a continued sequential and an overall expansion of our expectations for the...

Tom Steffen, Analyst — Stifel

That's great. Appreciate that. And then, you know, pivoting a bit more kind of big picture just on interventional glaucoma, you know, approaching 18 months into the Eidos launch. So kind of just wanted to ask about the state of the union with interventional glaucoma. What are the learnings, the puts and takes around those broader IG efforts? And Joe or Tom, where does the bullishness, your bullishness stand kind of in terms of the long-term opportunity with IG? Thanks.

Joe Gilliam, COO

Right, a bust of a company over the years. But I'll start, Tom, by acknowledging some of the I'm glad you asked the question. I think it was a good state-of-the-state snapshot of our industry today. And the numerous other folks here at Cloud Coast that are driving this top down and the ground up.

Operator

Your next question comes from Ryan Zimmerman with BTIG. Please go ahead.

Ryan Zimmerman, Analyst — BTIG

Thanks for taking the questions. Congrats on the quarter. And I appreciate you giving us the IDOS number and removing the guesswork on that one. So maybe just to start off with IDOS for a second, you know, you've made progress on certain MACs and others are still, you know, not fully there. Can you compare and contrast kind of the geographies in which MACs are fully covering IDOS without any disruption or any slowness? And how is the utilization, you know, amongst that physician base compared to, say, a territory or a state that's in a MAC that's an assumption?

Joe Gilliam, COO

Yeah, happy to touch on that, Brian. And as you commented, we did disclose the 31 million approximately sales of IDOs in the right direction. And the performance really was driven by utilization within those accounts who've been at it for a bit now. MAC regions where the professional fee has been established, driven again by widening surge in adoption over the course of 2025, that began to translate into procedures are the MACs who've had a professional fee schedule in place for a little bit. They represent a little over 50% of Medicare law, 50% of our IDOS volumes overall mix. And so I think that the trend that goes well for our business is that these other MACs finalize their IDOS and professional fee schedules here in the hopefully relatively near future. The second part of your question was kind of, you know, where do we summarize it and hang the J-code properly beyond and eventually the small to come around alongside the other.

Ryan Zimmerman, Analyst — BTIG

Sticking on the topic of professional fees for a moment and turning to the legacy MIG business. So, you know, we all saw the proposals. You know, I remember many years ago doctors were making, I think, close to $1,000 to implant the MIG. you know, we're now pushing around 100, maybe sub 100. We'll see. The question is more of a bigger picture question, though, on that topic, which is, you know, as the proceeds have come down, how do you think about legacy surgical glaucoma and the broader appeal to, say, non-glaucoma ophthalmologists, the comprehensive ophthalmologist who maybe was your marginal customer, you know, who was doing MIGs, as that comes down, does that get offloaded to the glaucoma specialist? I'm just curious kind of how you're thinking about maybe some of those economic

Joe Gilliam, COO

incentives. Yeah, I think, Ryan, so there's a couple things to unpack in your statement. The first one is, to a large extent, professional fees are about relativity in the context of the economics for that surgeon's time, whether that be in the context of chiropractic surgery, mixed procedures, standalone procedures, or the like. And if you heard Tom say, and we know from the proposed rule, what you've seen across many therapeutic categories, not just ophthalmology, but many others, and then certainly across the board in ophthalmology, is a wholesale shift in the way CMS is calculating the professional fee economics and the RVUs that drive them. And so I think there's an education process that has to happen led by the societies and the various groups that have a voice with CMS to help make sure that lands in the right prepared remarks. that we continue to remain financially viable as they move forward here and face that. I mean, to put that historical statement in context, we're $2,000 a procedure we've now seen over the last several years in cataract surgery,

Tom Burns, CEO

and we believe that's going to continue going forward. We have the immunization here on the current Category 3 codes of really high-paying standalone payments for I-dose and I-stet infinite. But I think as we go forward, these comprehensive ophthalmologists who are trying to recruit in cataract patients start waking up to the value of looking at glaucoma as a long-term treatment pattern and what we're calling the forever patient. And with the forever patient now, with a statutory time of 20-plus years from the time of diagnosis to leg termination, there'll be multiple opportunities for these surgeons to reenter and to re-implant with procedural pharmaceuticals and with SENS. And I think that will start to really resonate with these comprehensive ophthalmologists, not only as a more advanced standard of care for patients to stop the progression of glaucoma, but as an offset to the chewing that's happening on the professional T side for their cataract.

Ryan Zimmerman, Analyst — BTIG

Thank you for that complete answer there.

Chris Lewis, Head of Investor Relations

Welcome, Sven.

Operator

Your next question comes from Alan Gong with J.P. Morgan. Please go ahead.

Rohan, Analyst — J.P. Morgan

Hi, this is actually Rohan on for Alan. Thanks for taking the question. I just wanted to ask about the ramifications of the proposed reimbursement to start off, just the higher facility fee offsetting the lower physician fees. How are you thinking about that and the impact for that next year? And do you view it as more of a rising tide that lists all mixed boats? Or do you just want to get a sense for how you're thinking about it?

Joe Gilliam, COO

Yeah, I think, Rohan, you're talking about the proposed rule around the facility line with the pace of inflation. So I think in general that's a positive across the board for those folks who own and operate facilities and the manufacturers that provide tools and technologies there. As you think about the setup for the event.

Rohan, Analyst — J.P. Morgan

I just want to get a sense for what's driving that relative to expectations. And how are you thinking about SG&A growth? Do you think about it?

Alex Thurman, CFO

Or should we expect it? We want to point out that within that number, I'm going to speak to the total OPEX. Within the total OPEX number, there's about a $4 million one-time stock comp based on the triggering of certain performance awards that happened during the quarter. Look at that as the OPEX would have grown around 60 to grow in kind of the mid-teens. So that's kind of in line with what we would have expected, excluding that stock comp expense. And then if you think about it on a go-forward basis, again, speaking as a total OPEX, a reported second quarter number, and then the fourth quarter, maybe a sequential step up from there, when you put all that together, you're in the full year in kind of the $460 million range, which is more the top end of the range that we were thinking about previously. And that, again, translates to about, you know.

Chris Lewis, Head of Investor Relations

Thank you.

Operator

Your next question comes from Larry Beigelson with Wells Fargo. Please go ahead.

Simran, Analyst — Wells Fargo

Hi, this is Simran on for Larry. Thanks for taking the questions here. Just one on guidance. Any finer point on the cadence of sales in the back half? You know, as I think about the color that you've provided around IDOS and the different, you know, reimbursement updates with regards to the max, You know, should we be thinking about sort of an incremental step up in Q3 and, you know, something that's a little bit more Q4 weighted and just sort of what would that exit rate imply for, you know, IDOS beyond this year?

Joe Gilliam, COO

Yeah. It's Joe. So, you know, I probably, I'll call it the cadence from Q3 to Q4 is to dial in a bit on what you typically see in Q3. As you know, in ophthalmology, sort of in our business, Q3 tends to be a seasonally down quarter, just given summer holidays on a global basis. And if I put a finer point on that in the context of our various franchises, you know, the corneal health business tends to be kind of flat up a touch. But I think with lower device sales, patient growth for that product. The way to probably think about that is sequentially being a bit flat to what we saw in Q2 out of the cornea business. International glaucoma usually takes a couple million dollars step down in Q3. Okay, great.

Simran, Analyst — Wells Fargo

That's very helpful. And just for my follow-up, so we do continue to hear from physicians and our surveys that a high percentage of IDOS cases are done in combo cataracts. Can you share a national percentage with us, and how is that trending versus your?

Joe Gilliam, COO

Yeah, I think there can be some noise in your sampling there, obviously, and it's not something that we track closely, nor are we able to. As you know, when a facility orders Eidos, at the end of that, there's no direct relationship to knowing whether or not they've done an accommodation of cataract surgery or not. But having said that, you know, we believe that the largest utilization continues to be in standalone procedures. And as reimbursement gets solidified, we start to look at it in both settings where they're at, whether that patient is briefly turning to IDOS.

Operator

Your next question comes from David Saxon with Needham. Please go ahead.

David Saxon, Analyst — Needham

Great. Thanks for taking my questions. Congrats on the quarter. Sure. A couple for me, one on IDOS, and then I'll have one on Corneal Health. So first for IDOS, specifically for the reimbursement, do you think we'll be at a place exiting the year where maybe six or all seven of the max are paying out the J code with an established trophy? And is there anything that needs to be done outside of just getting cases submitted for the four that are lagging to kind of catch up?

Joe Gilliam, COO

yeah David so just I think first on the J code itself we're already largely seeing the heart of your

David Saxon, Analyst — Needham

okay great thanks for that and then on corneal health so after Epiaxa is approved how are you thinking about rolling out the Epiaxa cross-linking machine I understand it's going to machine so is that a trade-in is it a new purchase and then over what time would you expect to convert over to the new

Joe Gilliam, COO

Yeah, it's a good question, David. I'm not going to get too deep into the particulars, obviously, certainly in advance of an approval in hand. I think when we get to that point, we'll give a lot more context. But you raised, you know, one of many pertinent points around what will be the rollout and transition.

Chris Lewis, Head of Investor Relations

Okay, great. Thanks so much.

Operator

Your next question comes from the line of Joanne Woonch with Citi. Please go ahead.

Joanne Woonch, Analyst — Citi

Good evening, and thank you for taking the question. I'm catching up here a little bit with others reporting, so forgive me, but did you comment on the full-year guidance for IDOS based on what you are seeing in the market at this stage? And then for my second question, as we start to think about the Epioxa approval, how do you start to think about when that revenue may begin to ramp? And to your point, if patients are putting the procedure off until it is available, Is there a wait list that's starting, or is that too early? Thank you so much.

Joe Gilliam, COO

Yeah, so, hi, Joanne. First, on the IDOS guide, a bit of a repeat, and you'll be able to see it, and I think the remarks that become available. But really the punchline on IDOS is as you weave your way through the second half across the various franchises is that there's an implied, obviously, you know, it was in the second quarter, and really on the heel, and we continue to see that growing momentum that you'd hope for around the utilization of that, in particular in those regions where the professional fee has been established. There's a series of things running with any new drug, you know, rare disease categories, like through 2026, we expect to methodically unlock some of those. An important moment along that journey is to establish a JAPE. But even through the course of the year, you're educating, in this case, commercial dating policies. You're doing all the blocking and tackling to get standard of care. And you referenced, no, there wouldn't be any formal wait list. Those conversations aren't really happening, certainly not on behalf of Glaucos form. This comes from Adam Mader with Piper Sandler.

Operator

Please go ahead.

Adam Mader, Analyst — Piper Sandler

Good afternoon. Thank you for taking the questions, and congrats on the quarter. Two for me, both on Eidos, and I'll ask them up front. So first on the re-implantation decision from FDA, if I heard it in the prepared remarks correctly, it's early 2026. I thought before it was, you know, potentially before year end. So did we have a little bit of a wiggle there? And if so, you know, why the change in timing? And then secondly, for IDOS TRIO and the in-office opportunity, can you just put a finer point on timelines there and kind of what needs to be done to unlock the office opportunity for IDOS? Thanks for taking the questions.

Tom Burns, CEO

Adam, this is Tom. I'll be happy to take both those questions. So first of all, on the FDA's position with regards to IDOS re-implantation, I guess the wiggle, as you call it there, was the FDA recently classified our petition as an NDA supplement. And so with that gave us a FIDUFA date, which followed the statutory guidelines that they've set, which is now January 28, 20, 26, which gives a certainty now for understanding what the position will be. And so while we believe we've made a compelling case for re-implantation, as I've said in the past, I just want to alert the investment community that we are Not at all counting on a positive outcome. It would be a very formidable upside if we were able to get a number of patients in a non-facillus implantation. This will likely be a several-month-long process. With regards to IDOS TRIO itself, we've gone through several enhancements of the improved IDOS applicator. We continue to optimize the final engineering design, and as I've said before, we're designing this new approach within IDOS. the applicator will target an approximately one millimeter incision. And by doing so, it should allow us to perform a closed chamber procedure, which can maintain chamber pressure and minimize dehiscence of aqueous humor. And that's aqueous humor that would kind of percolate out during the procedure. And we have a final design, which is now targeted to enter a U.S. clinical trial by year end. And while the design itself and the clinical trial is relatively short, The FDA has asked us, so we'll now be targeting the approval by year-end 2027. Let me just say, this new product made in the TransDiviral Max, it is the first of what I anticipate will be many development efforts that we'll be making to optimize in-office implantation of IDOS. And I think the development of this product, as well as our subsequent products, comes at an enviable time. as current reduction of carbon continually drives surgeons to perform in-office implantation. So back in times in a new marketplace, as you think about where this could go, I do believe that people will look for multiple mechanisms. We'll see surgeons, as they already are, in infinite or reduced target pressures where they can arrest the progression of glaucoma. So I think we have an incredible opportunity in front of us in-office implantation over the next five to ten years, you deserve to go.

Chris Lewis, Head of Investor Relations

Great color. Thanks, Tom.

Operator

Your next question comes from Richard Newwitter with Truist Securities. Please go ahead.

Richard Newitter, Analyst — Truist Securities

Thank you for taking the question. Just the first one, I was wondering if you could characterize the utilization trends or really any kind of behavior you're noticing in situations where the prophy is established by max and without. And if you could specifically talk that everything from, you know, doc training, if you're noticing more docs getting trained or accelerating doc training in those situations or regions, to whether or not you're seeing combo cataract use potentially differ in, you know, prophy on or prophy established situations. and then if you could also characterize the utilization differences between the national average and the region free.

Joe Gilliam, COO

Yeah, Richard, and some of this will be, you know, a bit of a rehash from earlier in the call, but I'm happy to do it as you think about what's going on. I think the most important overall statement, the continued acceleration in surgery, really are contained within Novotis, Neridia, or First Coast. you're seeing outperformance relative to the other areas of the country.

Richard Newitter, Analyst — Truist Securities

That's really helpful. And just a quick follow-up. Thanks for the sequential color, 2Q to 3Q and then 3Q to 4Q. I just want to clarify, did you say that U.S. glaucoma would be up quarter over quarter? 2Q is obviously up sequentially and quarter positive.

Joe Gilliam, COO

On vacation, there's a lot left.

Operator

Your next question comes from Michael Sercone with Jeffries. Please go ahead.

Michael Sercone, Analyst — Jeffries

Good afternoon, and thanks for taking the question. Just had a follow-up on the U.S. high-cent business. It looks like it might have declined about 10% in its declines. And Harris here, but, you know, what trends would kind of occur where that performance would improve somewhat off of a kind of high single-digit, low double-digit decline?

Joe Gilliam, COO

Question, Michael. I'd say there's two things going on there. That's something that we've seen the peak of.

Michael Sercone, Analyst — Jeffries

Got it. That's really helpful, Joe. And then maybe a quick follow-up. I think in some of the prepared remarks at the opening of the call, you had mentioned X, some of the investments made in 2Q, you might have generated about $4 million of cash from operations. Just wanted to dig a little deeper there. And, you know, on an underlying basis, you know, how are you thinking about cash flow generation in the near and midterm?

Alex Thurman, CFO

Hey, Mike, it's Alex. I'll take that one, and just to give you a little more flavor on the cash for the quarter and what Tom was saying in his prepared remarks, if you look at the change in cash between the end of the last quarter and the end of this quarter, that change has actually declined about $25 million. But as Tom mentioned in his remarks, there were a few transactions that occurred in the The first was the purchase of a building adjacent to our headquarters, and the second was the acquisition of Mobius Therapeutics. The sum of those is about $30 million. So when you take that and take that out of the negative 25, you end up, it's actually $29 million. So you end up around a plus generation in the quarter, and that's kind of the details around that. As we think about going forward, again, we continue to have the near-term goal to manage our business such that we, or maybe small amount, continues our revenues and cash generation against the investments needed in both sidelines.

Joe Gilliam, COO

I think it's also worth adding that with IDOS growth, clearly we have long-dated terms, as you expect with any new product launch. And so as we make our way through and you see this, there's a lag effect there to the cash flow benefit, the earliest of which you're starting to see, obviously, in the Q2 period.

Chris Lewis, Head of Investor Relations

Really helpful.

Operator

Your next question comes from Mason Carrico with Stevens. Please go ahead.

David Saxon, Analyst — Needham

Hey. Hey, thanks for fitting me in here. I'll ask my two up front if that's easier here. When it comes to commercial payers, what are your expectations around how IDOS is implemented into those coverage policies? I mean, is there an opportunity for it to be incorporated first line?

Joe Gilliam, COO

Should we be thinking about it as a second or third line potentially? And then as a second question, could you give us some insight into where IDOS margins stand today? as that product become accretive to overall corporate gross margins. Thanks. Yeah, Mason, I'll start off with Alex's question there. The good news is on the commercial payer policies, we actually have a pretty high number of policies that we can point to in support of this answer. I mean, in fact, both on the commercial policy standpoint as well as Medicare Advantage, over 50% of lives have a positive policy in place. The remainder are silent and every day it goes by, we're adjudicating claims within those environments to get confidence that patients with those work on evidence. And then

Alex Thurman, CFO

based on the margin, you know, it's a great question and I'm glad you asked it because we were really pleased to see the margins come in at 83% in the quarter and that represented really modest accretion both on a year-over-year and a quarter-over-quarter basis and it also continues to be in this 82-84% range that we've been guiding to all year. And we've said for some time now that with Eidos, as you mentioned, you know, that that is a high-margin product. It was success in the commercialization of Eidos and the gross margin over time, and we hope to see modest accruciation.

Chris Lewis, Head of Investor Relations

Got it.

Operator

Your next question comes from Anthony Petroni with Mizuho. Groot, please go ahead.

Anthony Petrone, Analyst — Mizuho

Thanks. And I'll stick to two on Eidos here. And one may be just when you think about the cadence that we're seeing now, I mean, how much is from, you know, sort of early adopters here that have been, you know, with IDOS now maybe for a few quarters, them increasing utilization versus new physician ads, and then maybe just an update on managed care coverage, you know, for IDOS. It sounds like, based on some channel checks, you're starting to see a little bit of movement there, no official formulary coverage, but there is some claims being processed. So anything you can share on the managed care front for IDOS would be helpful.

Joe Gilliam, COO

Yeah, Anthony, you know, first around both, as you know, procedures and when they get scheduled. And so combined with increasing utilization of those early adopters. Your final question comes from Danielle and Healthy with UBS.

Operator

Please go ahead.

Danielle Antalffy, Analyst — UBS

Hey, good afternoon, guys. Thanks so much for taking the question. Congrats on a strong quarter here. Just a question on where you're seeing physicians adopt IDOS. Could you maybe talk a little bit about how they're balancing IDOS versus ISENT and sort of what the decision pathway is to go with IDOS versus ISENT? and maybe just because it could serve as a snapshot of, you know, five years from now how these two different product lines are coexisting. Thanks so much.

Joe Gilliam, COO

Yeah, thanks, Danielle. And obviously it's still early days, and so we're on those physicians who are adopting and are at the phase that Anthony's prior question are earlier adopters who are now moving into a part of their everyday, you know, practice paradigm in managing patients with glaucoma. And I think what you're starting to see for those folks who are in that is that iDose becomes their foundational therapy. That's where they go first and foremost. That shouldn't be a surprise given how wide open that label is and the ability to treat patients up and down the disease spectrum. And they then turn increasingly to the iSend or iSend Infinite, whether that be standalone or in combination at times with iDose, to manage those patients who are progressing. They may have failed on a few more therapies along the way, and they want to make sure that they really take every chance to arrest the progression of that disease and hopefully avoid the progression towards a more invasive procedure like a tube of trash.

Operator

That concludes our question and answer session. I will now turn the call back over to the company for closing remarks.

Tom Burns, CEO

Okay. Thank you all for your time and attention today, and again, we thank you for your continued...

Operator

Ladies and gentlemen, this concludes today's call. Thank you all for joining. You may now disconnect.