Perspectives on Medicare’s Proposed iDose TR Coverage Policy - Scorecard - MDSpire
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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). Glaucoma Physician spoke with several leading surgeons who expressed concerns about the proposed LCDs and suggested 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

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Clinical Scorecard: Perspectives on Medicare’s Proposed iDose TR Coverage Policy

At a Glance

CategoryDetail
ConditionGlaucoma
Key MechanismsSustained drug-delivery therapies for glaucoma management.
Target PopulationPatients with glaucoma who have failed medical management and selective laser trabeculoplasty.
Care SettingOphthalmology 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.

Related Resources & Content

    Original Source(s)

    Perspectives on Medicare’s Proposed iDose TR Coverage Policy

    • 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

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