Glaukos Corporation has launched its corneal crosslinking (CXL) treatment Epioxa HD (riboflavin 5’-phosphate ophthalmic solution) 0.239% / Epioxa (riboflavin 5’-phosphate ophthalmic solution) 0.177% to the U.S. commercial market.
The news follows less than 5 months after the FDA approved Epioxa for the treatment of keratoconus.
So with that in mind … where do we begin?
With a refresh: Epioxa (pronounced E-pee-ox-ah) is the first and only FDA-approved (epithelium [epi]-on), minimally-invasive corneal CXL therapy for keratoconus.
What it is: A novel, oxygen-enriched topical therapeutic bioactivated by ultraviolet (UV) light and designed as an incision-free alternative to traditional CXL procedures.
Its indication: For use in epi-on corneal collagen CXL to treat keratoconus in adults and pediatric patients (ages 13+).
- To be more precise: Epioxa reduces the duration, complexity, and pain of treatment (not to mention shortens the recovery time).
Its recommended dosage: Both Epioxa and Epioxa HD are available as single-dose syringes administered via topical ophthalmic application.
- See here for its full prescribing information.
I need more info …
- For a look at how Epioxa halts disease progression, click here.
- Details on Epioxa / Epioxa HD’s novel formulations can be found here.
- Curious on how it compares to prior keratoconus therapies? See here.
- Speaking of other comparisons: Check out how it differs from Photorexa
- Hint: Epi-on versus epi-off means two different things …
Is it associated with any contraindications or adverse effects?
Just a few, with the potential adverse reactions linked back to the clinical trial data that supported the FDA’s approval.
- Contraindications can be found here.
- For more on those adverse effects (which, take note, occurred in 5% to 25% of trial participants), see here.
- And if you’re curious, you can check out this recap of the phase 3 trial data.
And have clinicians weighed in yet on the clinical implications of this therapy?
Check out this conversation between Glance President Jackie Garlich, OD, FAAO, and Glaukos’ Rutvi Doshi, OD, global medical lead, Corneal Health.
- See also input from Eric D. Donnenfeld, MD, and Mitch Ibach, OD.
As Dr. Donnenfeld previously told Glance:
"An oxygen-enriched environment (such as the one provided by Epioxa) is critical to the success of CXL … as corneal surgeons, we have an obligation to our patients to preserve vision, improve quality of life, and to avoid corneal transplantation in these young patients.”
- He added: “The introduction of Epioxa is an important step forward towards this important goal."
Amazing. Now let’s talk patient access.
Ahead of this commercial launch, Glaukos introduced a new patient access support program called EpioxaCareConnect.
The program is designed to offer support for patients via a wide range of services, including basic access and reimbursement, financial options, and specialty pharmacy assistance.
Tell me more about these services.
Through its access and reimbursement services, the program can:
- Perform a benefits investigation
- Provide prior authorization requirements
- Offer estimated patient out-of-pocket (OOP) costs
- Determine financial assistance eligibility
And speaking of financial assistance, two options are available:
- Epioxa Copay Program for insured patients to minimize their OOP costs for both Epioxa and the CXL procedure
- Patient Assistance Program (PAP) for eligible U.S. residents, both uninsured and underinsured
Any other resources through this program?
Two more worth noting, starting with specialty pharmacy support. Clinical practices utilizing Epioxa can send specialty pharmacy prescriptions directly to EpioxaCareConnect.
- Providing a payer allows Epioxa access via a specialty pharmacy, the program will work directly with the pharmacy to fill the prescription and provide financial assistance for patients.
And lastly, each patient enrolled in the EpioxaCareConnect program is paired with a patient access liaison (PAL) member who offers “one-on-one, non-medical support” by:
- Answering logistical questions
- Guiding patients through insurance and access processes
- Ensuring a smooth start to Epioxa treatment
The PAL’s support will also continue following a patient’s first-eye treatment to aid in recovery, as well as (if needed) coordinating a second-eye treatment.
Lastly: What support is offered for clinical practices offering Epioxa?
Eyecare providers can head over to Epioxa’s official website for healthcare professionals to learn more about the program’s wide range of resources.
Among these: the EpioxaCareConnect patient enrollment form; billing and coding tools to support access and appropriate reimbursement; and patient-friendly education materials on coverage, insurance processes, and financial assistance options.
Editor's note: This article was updated on March 19, 2026.