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

Objective:

To discuss the implications of Medicare's proposed local coverage determinations (LCDs) for iDose TR on patient care and glaucoma treatment practices.

Approach:

Expert Opinions: Six glaucoma specialists provide insights on the proposed LCDs, highlighting concerns about their alignment with contemporary glaucoma practices.

Key Findings:

The proposed LCDs require patients to fail medical management, generally defined as failure of at least 2 topical medications or intolerance or inability to use them, and selective laser trabeculoplasty (SLT) before considering iDose TR.
The LCDs treat procedural pharmaceuticals as similar to MIGS procedures, which many specialists argue misrepresents their role in glaucoma treatment.
Experts emphasize the need for policies that reflect the actual use and benefits of sustained drug-delivery therapies.

Interpretation:

Many glaucoma specialists express concerns that the proposed LCDs do not accurately reflect the clinical rationale for sustained drug-delivery therapies and could limit patient access to effective treatments.

Limitations:

The proposed policies may not account for individual patient needs and the variability in glaucoma treatment.
Restrictions on concurrent procedures could lead to increased costs and additional surgeries for patients.