Harrow Health Projects Robust Growth After Strong 2025

Harrow Health ((HROW)) has held its Q4 earnings call. Read on for the main highlights of the call.

Harrow Health’s latest earnings call struck an upbeat tone, with management emphasizing robust 2025 results, accelerating product momentum, and a clear path to stronger profits and cash flow. While executives flagged several near-term headwinds and higher spending needs, they framed these as temporary issues against a broadly growth-oriented outlook through 2026 and beyond.

Strong Revenue Growth

Harrow reported consolidated Q4 2025 revenue of $89.1 million, up 33% year over year, underscoring the strength of its expanding branded ophthalmic portfolio. Full-year 2025 revenue reached $272 million, a 36% jump versus 2024, showing that growth is coming from multiple products rather than a single blockbuster.

Meaningful Profitability and Cash Generation

Profitability moved sharply higher, with adjusted EBITDA of $24.2 million in Q4 and $61.9 million for 2025, representing 54% year-over-year growth in earnings power. Operations generated roughly $44 million of cash during the year, and Harrow ended 2025 with $72.9 million in cash and equivalents, giving it solid financial flexibility.

BYOOVIZ Outperformance

Biosimilar BYOOVIZ continued to outperform, posting Q4 revenue of $25.9 million, up 14% sequentially as more physicians adopted the Lucentis-referenced product. For 2025, BYOOVIZ generated $88.7 million in revenue, rising 216% versus 2024 and confirming its role as a key growth engine in the retina segment.

Accelerating IHEEZO Momentum

IHEEZO delivered Q4 revenue of $35.9 million and $81.3 million for the full year, backed by 64% quarter-over-quarter and 65% year-over-year unit demand growth. Retina now represents roughly 70% of Q4 unit volume, ordering accounts rose 49% versus last year, and management highlighted expected H2 2026 pricing gains and new retina-focused packaging.

Rapid TRIESENCE Adoption

TRIESENCE is ramping quickly, with Q4 revenue of $5.1 million, a 36% increase over Q3, and full-year 2025 revenue of $9.9 million, up 193% versus 2024. To deepen penetration in ocular inflammation and surgical settings, Harrow is doubling the dedicated TRIESENCE sales force and advancing Phase 3 and IND efforts for a potential cataract label expansion.

VEVYE Commercial Inflection

Dry eye therapy VEVYE is showing early inflection, as the number of prescribers writing the drug grew 115% and patients average about nine refills a year, implying roughly one year of persistence. With broader payer coverage now in place and plans to more than double the VEVYE sales team, management believes VEVYE can scale into a high nine-figure annual product over time.

2026 Guidance and Upside Pathway

For 2026, Harrow guided revenue to $350 million to $365 million and adjusted EBITDA to $80 million to $100 million, with a clear second-half weighting as new initiatives mature. The company expects H1 revenue of $133 million to $153 million and H2 of $203 million to $226 million, driven by launches, expanded sales forces, and pricing tailwinds across its core brands.

Pipeline and M&A Synergies

Following the Melt acquisition, Harrow is prioritizing G-MELT and YOCHIL, positioning G-MELT as a potential large, opioid-free procedural sedation product with an NDA targeted for early 2027. Management also flagged multiple upcoming IHEEZO clinical readouts, including investigator-initiated data at a major retina meeting in July 2026 and a company Phase 4 study readout by year-end 2026.

Operational Investments to Support Scale

To support its broadening portfolio, Harrow plans to add roughly 100 sales roles in the first half of 2026 and to double the teams behind VEVYE and TRIESENCE. SG&A will rise to support major launches such as VEVYE, TRIESENCE, BYOOVIZ, and BYQLOVI, but management stressed its continued focus on profitability and cash generation even as it invests for growth.

Near-Term Channel and Seasonality Headwinds

Management cautioned that the first half of 2026, especially Q1, will be softer as the market works through a channel inventory drawdown, particularly for IHEEZO where Q4 demand created about 1.5 quarters of extra stock. Insurance resets and a heavier mix of high-deductible health plans will further mute reported Q1 revenue, with limited IHEEZO revenue recognition despite healthy underlying demand.

Loss of ASC Pass-Through for IHEEZO

IHEEZO faces a reimbursement headwind when it loses pass-through status for ambulatory surgery centers on April 1, 2026, affecting a channel that accounted for roughly 30% of 2025 units. Harrow aims to offset this blow by expanding in-office usage, tapping into an estimated additional 2.5 million procedures, though the timing and completeness of that offset remain uncertain.

Temporary Compounding Supply Constraints

Harrow’s rare disease and compounded portfolio was pressured in 2025 by inventory and compounding constraints that curtailed near-term sales. Management expects these supply issues to normalize by the end of Q1 2026, but acknowledged that the disruption reduced revenue and required remediation efforts that temporarily weighed on the business.

Increased Operating Spend and Margin Pressure

The company expects SG&A expenses to rise to roughly $185 million to $205 million in 2026 and R&D to reach $30 million to $35 million to fund hiring, launches, and clinical programs. While this will create near-term margin pressure, Harrow still projects higher adjusted EBITDA for the year as revenue growth outpaces the spending ramp.

One-Time and Acquisition-Related Charges

Fourth quarter results included an $8.5 million acquired and processed R&D charge tied to the Melt transaction that flowed through the income statement. Management characterized these acquisition-related items as non-recurring in nature, noting that their timing can temporarily distort earnings trends even as they support future product opportunities.

Regulatory, Reimbursement and Execution Risks

Executives also underlined several areas of execution risk, including upcoming reimbursement decisions, pricing dynamics for Melt-acquired products, and the timing of future regulatory filings such as the G-MELT NDA. While the company’s tone was confident, leadership acknowledged that approvals, coding outcomes, and commercialization timelines are not guaranteed and could influence the growth trajectory.

Forward-Looking Guidance and Outlook

Looking ahead, Harrow’s guidance points to another year of double-digit revenue growth in 2026 and a sizable step-up in adjusted EBITDA, weighted toward the back half as investments start to pay off. Management expects Q1 to be the weakest quarter, with compounding revenue of about $60 million to $65 million in 2026 and important milestones across IHEEZO, VEVYE, TRIESENCE, and Melt pipeline assets shaping investor sentiment.

Harrow Health’s earnings call painted the picture of a specialty eye-care company using its strengthened balance sheet and cash flows to press its advantage in multiple high-value niches. For investors, the story hinges on whether Harrow can navigate near-term reimbursement and channel challenges while executing on its aggressive growth and pipeline plans into 2026 and 2027.