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

At a Glance

Category	Detail
Condition	Glaucoma
Key Mechanisms	Sustained drug-delivery therapies for glaucoma management.
Target Population	Patients with glaucoma who have failed medical management and selective laser trabeculoplasty.
Care Setting	Ophthalmology practice and surgical settings.

Key Highlights

Proposed LCDs require failure of at least 2 topical medications and SLT before considering iDose TR.
Implantation may not occur concurrently with other ophthalmic surgeries, except cataract surgery.
Concerns raised about the proposed LCDs not reflecting contemporary glaucoma practices.
Experts argue procedural pharmaceuticals should not be treated like MIGS procedures.
The public comment period for the proposed LCDs ended on July 4, 2026.

Guideline-Based Recommendations

Diagnosis

Assess patient history and previous treatments for glaucoma.

Management

Consider iDose TR after failure of topical medications and SLT.

Monitoring & Follow-up

Evaluate patient response to treatment and adjust management as necessary.

Risks

Potential for increased costs and patient burden if multiple procedures are required.

Patient & Prescribing Data

Patients with glaucoma requiring advanced treatment options.

Sustained drug delivery may reduce the need for additional surgeries and improve compliance.

Clinical Best Practices

Utilize evidence-based guidelines for glaucoma treatment.
Consider individual patient circumstances when determining treatment pathways.
Advocate for policies that reflect the clinical realities of glaucoma management.