Eyeworld

FALL 2026 | EYEWORLD | 69 C Relevant disclosures Lee: Glaukos Majmudar: Epion Therapeutics, Glaukos Rajpal: Glaukos, Horizon Surgical Saricay: Alcon, Dompé, Glaukos Contact Lee: wblee@mac.com Majmudar: pamajmudar@yahoo.com Rajpal: rrajpal@seeclearly.com Saricay: Leyla.yavuzsaricay@ childrens.harvard.edu procedure. With the epi-on procedure, Glau- kos launched EpioxaCareConnect as a patient support resource that can help with "benefit investigations, prior authorization and appeals, and financial assistance resources," according to the company. Dr. Saricay said that reimbursement chal- lenges are relatively common with new technol- ogies, but the preauthorization and reimburse- ment for her first Epioxa case went smoothly. Dr. Rajpal said that prior authorization review will still be required with the epithelium-on procedure, and some peer-to-peer meetings may be needed until payers' policies become stan- dardized, but he expects this transition to be relatively smooth. "Glaukos has put a tremendous amount of energy and resources into supporting practices and patients on this journey. There is a strong specialty pharmacy program so that practices do not have to buy the medications up front, and patient assistance programs can reduce the deductible co-payment for commercially insured patients to $0 and provide the medications for free for eligible uninsured patients. The EpioxaCareConnect HUB should greatly reduce administrative burdens for crosslinking provid- ers," Dr. Rajpal said. Dr. Rajpal also mentioned a J code that took effect for Epioxa on July 1. He said all five of the largest insurance payers have already indicated they are receptive to Epioxa's clinical value. "I suggest that practices work closely with Glaukos and take advantage of the support programs. In addition, I would encourage phy- sicians to request a peer-to-peer review meeting when a claim is denied because these meetings are what help to change payer policies," he said. Dr. Lee expects more ophthalmologists will do the procedure than when only epi-off was available. "… it now carries little risk to patients with a huge upside of halting progression of the disease," he said, adding later that "epi-on tech- niques will improve the efficiency of the proce- dure and reduce potential patient complications compared to epi-off techniques. Widespread adoption will require appropriate insurance coverage of the procedure for both the CPT code and the J code for the medication." One financial strategy while J code cover- age by insurance providers is sorted out that Dr. Lee mentioned is outsourcing drug ordering of Epioxa through specialty pharmacies. "Glaukos has recommendations of how this can be done, and it will protect practices in the early stages from loss of revenue from the drug cost," Dr. Lee said. A message for referring doctors There's no such thing as "too soon" when it comes to referring a keratoconus suspect to a cornea specialist who performs crosslinking, Dr. Saricay said. "I want every optometrist or ophthalmologist to feel comfortable referring patients to me when there is even a slight concern or a family history of keratoconus," she said. "That is the path to catching this disease at an earlier stage." Dr. Saricay said she's excited that innova- tion in this area is driving greater awareness of the disease state overall. "I want people to ask me, 'Do you think I have keratoconus?' because it means that people are becoming more educat- ed and proactive about this disease," she said. Dr. Rajpal said crosslinking should be the first step for every keratoconus patient, espe- cially young patients. "There is no benefit to characterizing a referral as 'too soon' or 'too late.' There is only the question of whether they are being diagnosed and treated soon enough to preserve good vision," he said. Limits to epi-off crosslinking As noted in the article, Glaukos will pro- vide limited quantities of Photrexa under a medical necessity program, based upon physician request to those who think the epi-off procedure is required medically for the patient. "Maintaining a limited inventory to support ongoing access to Photrexa when the phy- sician deems it to be medically necessary is in the best interest of the patient. It's good to have that flexibility while we continue to gain confidence with the new technology," Dr. Saricay said. "Phasing out epithelium-off crosslinking is the appropriate thing to do so that patients can have insurance access to the newer, epithelium-on procedure," Dr. Rajpal said. "The availability of Photrexa will be limited to select, individual cases when a doctor determines it is in the patient's best interest."

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