Perspectives on Medicare’s Proposed iDose TR Coverage Policy

In May 2026, 5 Medicare Administrative Contractors released proposed Local Coverage Determinations (LCDs) addressing Medicare reimbursement for anterior-segment intraocular nonbiodegradable drug-eluting systems, a category that currently includes only the travoprost intracameral implant iDose TR (Glaukos). Many glaucoma specialists believe the proposed LCDs do not reflect contemporary glaucoma practice or the clinical rationale underlying sustained drug-delivery therapies. Glaucoma Physician spoke with several leading surgeons about the proposed LCDs, the reasons for their concerns, and the changes they believe would better reflect contemporary glaucoma practice.

By
Steven R. Sarkisian, Jr., MD
Inder Paul Singh, MD
Savak “Sev” Teymoorian, MD, MBA
Manjool Shah, MD
Christine Funke, MD
Philip S. Garza, MD, MSc
September 1, 2026
10 min

Glaucoma Physician

Background

The proposed LCDs for iDose TR, a drug-eluting implant for glaucoma management, have sparked significant debate among glaucoma specialists. These policies could limit access to innovative treatment options for patients who have not responded adequately to traditional therapies.

Data Highlights

No numerical data or trial data provided in the source material.

Key Findings

The proposed LCDs classify iDose TR as a procedural pharmaceutical, which some specialists argue misrepresents its role in glaucoma treatment.
Coverage is proposed only after patients have failed at least two topical medications and selective laser trabeculoplasty (SLT).
The proposals prohibit concurrent implantation of iDose TR with other ophthalmic procedures, except cataract surgery.
Many glaucoma specialists believe the proposed restrictions do not align with contemporary clinical practices.
Concerns were raised about the implications of a 'wait and progress first' approach to treatment.
Public comments were submitted by various stakeholders, including the American Glaucoma Society, during the comment period ending July 4, 2026.

Clinical Implications

The proposed LCDs may restrict access to iDose TR for patients who could benefit from this therapy, particularly those who do not respond to traditional treatments.

Conclusion

The ongoing discussions surrounding the proposed LCDs for iDose TR highlight the need for policies that accurately reflect the role of innovative therapies in glaucoma treatment.