Glaukos Corporation (NYSE:GKOS) Q3 2023 Earnings Call Transcript

Tom Stephan: Got it. And maybe I’ll call this question 2b. But pivoting to iDose, I wanted to ask about just stock trainings. Joe or Tom, any sense you can give us for how to think about the ramp in 2024? Will it be deliberately, methodical or early on as you work through establishing full reimbursement? And then what’s a reasonable annual cadence of doctor trainings in the first couple of years as we refine our models. We look back at the iStent training ramp. There were periods early on that I think you trained 700, 800 physicians per year, nothing makes much less well-established. But now you have, what, 5,000 plus mix trained doctors. So for iDose, is it reasonable to think doctor trainings could approach 1,000 per year for the first couple of years? Thanks for talking the question.

Tom Burns: No problems. I mean, struck three in for one, but we’ll go ahead and honor it. it’s all good. From a DUC standpoint, we’re going to take the same approach we’ve always taken. And so I wouldn’t say even just the beginning. I’d say for the entirety of 2024, we’re going to be methodical as it relates to driving superlative outcomes in the case of the doctors that we’re training on iDose. We’ve always done it that way. Now obviously, in those early days, let’s call it, in the first half of the year, that will be even more the case and that we’ll go out to a handful of surgeons that we know work well in these early-stage training situations, make sure that we’ve nailed down the training algorithm for our sales force before we start to expand from there.

I think the other key gating item that I would point to as it relates to the pace of training is reimbursement itself. So as you transition from a miscellaneous code to a permanent code as you start to establish more regular and recurring payment on the professional fee, and even the facility fee side associated with iDose, more and more surgeons and their practices will be ready, willing and able to be trained. And so those things also play a role in this. You referenced historical statistics and they’re accurate. I think at our peak, we were training somewhere between 700 and 800 docs a year on the iStent technologies, first generation, a lot of which was teaching them angle based surgery. As we move forward, I think that lift on the angle will be a little bit less.

So we would have expectations that as we hit a steady run rate that we can train more doctors than that 700, 800 historical run rate with iDose. But to get more specific than that, it’s hard until we really get at that stage of the deployment.

Tom Stephan: Very helpful. I’ll keep it to one next time. Thanks guys.

Tom Burns: Thanks.

Operator: All right. Our next question comes from the line of Ryan Zimmerman from BTIG. Ryan, please go ahead.

Ryan Zimmerman: All right. I’m going to stick to the rules here and ask just one and the follow-ups. So number one, I’m going to ask for Tom. Tom, you’re in the process, I think, of having conversations with FDA about labeling the iDose. I don’t know what you’re comfortable saying, but what can you say in terms of where you’re at and the early read on what the label could look like for iDose?

Tom Burns: Yes, Ryan. I’m happy to respond. And as you — I think you stated earlier, these would be highly preliminary. And most of these would be based on our deep briefing from the mid-cycle review that we had midyear. So what I will tell you is we have yet to receive a draft label. So as we said previously, while we’re confident in the strength and robustness of our clinical data, you never know for sure where the label will land and whether the FDA will view the data using the same prism as we do until that process is finalized. What I will tell you is that we remain confident that we’re tracking towards the PDUFA date of December 22. But that’s really as far as I can assure you at this point.