Harrow (HROW) Q1 2025: Vivi Revenue Jumps 35% as Access Program Accelerates Prescription Growth
Vivi’s prescription surge and the launch of the Access for All program set up Harrow’s most valuable product for outsized growth in the back half of 2025. Despite typical Q1 seasonality and one-time costs, Harrow’s diversified ophthalmic portfolio is positioned for sequential gains, with market access wins and compounding business stability providing visible levers for guidance delivery. Management’s conviction in exceeding $280 million revenue guidance rests on accelerating refill momentum, normalization in IHESO, and a pivotal inflection in Triessence adoption.
Summary
- Vivi Access Program Drives Prescription Inflection: Early momentum quadrupled weekly prescribers, positioning Vivi as Harrow’s future anchor asset.
- Triessence and IHESO Normalize for Growth: Market access and destocking set up both brands for sequential revenue acceleration.
- Guidance Confidence Rooted in Portfolio Diversity: Management sees upside from multiple brands, not just Vivi, with record compounding business stability.
Performance Analysis
Harrow’s Q1 results reflected both the company’s well-telegraphed seasonal softness and the early impact of major commercial initiatives. Total revenue grew 38% year over year, with record $19.7 million in cash flow from operations, demonstrating strong underlying business momentum. Vivi, Harrow’s flagship ophthalmic prescription product, was the standout, with revenue up 35% sequentially to $21.5 million, even before the full benefit of the new Vivi Access for All (VAFA) program. This program, launched at the tail end of the quarter, has already quadrupled weekly new prescribers and prescriptions, setting the stage for compounding refill growth in the second half.
IHESO, intraocular steroid, saw Q1 sales impacted by end-of-2024 distributor stocking, but unit sales more than doubled in April as destocking normalized. Triessence, intraocular injectable, completed critical market access steps in Q1, including pass-through reimbursement and published average selling price, unlocking about 40% of its addressable market from April onward. The compounding business, ImprimisRx, remained a core profit and relationship engine, delivering consistent revenue and record April performance. Gross-to-net volatility in specialty branded products weighed on Q1 recognized revenue, but this is expected to stabilize as new programs gain traction.
- Vivi Refills Set to Compound: Management expects refill rates averaging nine per year per covered patient, amplifying revenue as new prescriptions stack in Q3 and Q4.
- IHESO Returns to Growth: April unit sales more than doubled Q1 monthly averages, signaling a rebound after Q1 destocking.
- Triessence Market Access Win: Pass-through and bilateral use reimbursement effective April 1st have doubled account openings YTD, a leading indicator of volume ramp.
One-time expenses, including audit and special projects ($3.7 million), weighed on Q1 margins, but management is comfortable with the current cost structure given expected operating leverage as revenue scales across the portfolio.
Executive Commentary
"Vivi revenue rose 35% sequentially from $16 million in the fourth quarter of 2024 to $21.5 million in the first quarter of 2025. And that was even before the launch of the VBI Access for All program, which happened at the very end of the first quarter...both new prescriptions and weekly Vivi prescribers at PhilRx have quadrupled."
Mark Elbaum, Chief Executive Officer
"Our expectation is that ASP is going to be higher with Viva Access for All than it was prior last year. And then importantly, the volumes that we're seeing from an increased perspective are incredible. And one of the things that I love about Viva...is that mathematical compounding you get on the refills, that sort of annuity you get with the refills."
Andrew Boll, Chief Financial Officer
Strategic Positioning
1. Vivi Becomes Core Growth Engine
Vivi, cyclosporine ophthalmic solution, is now positioned as Harrow’s most valuable asset. The Access for All program has dramatically expanded patient and prescriber reach, with refill rates and new prescription velocity outpacing initial expectations. Management projects Vivi could deliver at least $100 million in 2025 revenue, with upside as refill compounding and new prescriber adoption accelerate through Q3 and Q4. The economics per patient are robust, even at lower out-of-pocket prices, due to insurance coverage and refill frequency.
2. Triessence Market Access Unlocks TAM
Triessence, intraocular injectable steroid, achieved a pivotal reimbursement milestone in Q1. The product now has published ASP and pass-through status, enabling reimbursement outside bundled fees for ASCs and hospital outpatient departments—historically 40% of the market. Account openings have more than doubled since January, with “dabblers” expected to convert to higher utilization as reimbursement confidence grows. Management expects Triessence to become the leading intraocular steroid in the U.S. ophthalmic market.
3. IHESO Recovers as Inventory Normalizes
IHESO, intraocular steroid, saw Q1 sales dampened by distributor destocking following elevated Q4 stocking. April data show unit sales have more than doubled, indicating a return to growth. New institutional accounts are ramping, and the top 10 pipeline accounts could add 80,000 incremental annual units. Management targets over $50 million in 2025 IHESO revenue, with sequential growth expected as the year progresses.
4. Compounding Business Remains Strategic Asset
ImprimisRx, compounding pharmacy, continues to provide revenue stability and commercial leverage. The business supports over 10,000 eye care professionals and serves as a pipeline for transitioning patients to branded FDA-approved products like Vivi. Project Beagle, the migration of Clarity C patients to Vivi, is expected to double profit contribution per patient, even at lower cash pay prices, and demonstrates the strategic value of compounding relationships for cross-selling and lifecycle management.
5. Portfolio Diversification Reduces Risk
Harrow’s revenue guidance is not solely dependent on Vivi. Management expects at least $50 million each from Triessence and specialty branded products, and $80 million from compounding. Q1 softness in certain segments is expected to reverse as market access initiatives and pricing strategies take hold.
Key Considerations
Harrow’s Q1 was a transitional quarter, with seasonality and one-time costs masking the early impact of major commercial initiatives. The company’s ability to deliver on its $280 million guidance hinges on execution across multiple brands, not just Vivi.
Key Considerations:
- Vivi Access Program’s Early Impact: Quadrupling of prescribers and prescriptions is a leading indicator for outsized Q3/Q4 growth.
- Triessence Reimbursement Drives Adoption: Expanded reimbursement unlocks 40% of market, with account growth already visible in Q2.
- IHESO Inventory Normalization: Destocking headwinds are behind, and April unit growth signals a return to upward trajectory.
- Compounding as Strategic Pipeline: Project Beagle transition of Clarity C patients to Vivi demonstrates cross-sell potential and profit leverage.
- Cost Structure and Margin Leverage: One-time Q1 expenses are not expected to recur, setting up operating leverage as revenue scales.
Risks
Execution risk remains around the pace of Vivi prescription compounding, successful conversion of Triessence “dabblers” to high-utilization accounts, and management of ASP (average selling price) across buy-and-bill products. Gross-to-net volatility could persist in specialty brands, and while tariff impacts are minimal, broader macro or reimbursement shifts could influence volumes and margins. Debt refinancing is flagged as a near-term overhang, though management expresses confidence in reaching a favorable outcome by late summer or early fall.
Forward Outlook
For Q2 2025, Harrow expects:
- Sequential revenue growth across Vivi, IHESO, and Triessence as refill and account ramp effects compound.
- Stabilization of ASP for Vivi as Access for All volumes offset lower per-script pricing.
For full-year 2025, management reiterated guidance of over $280 million in revenue:
- Vivi targeted for $100 million-plus, with upside as refill compounding accelerates.
- IHESO and Triessence each expected to deliver $50 million-plus.
- Compounding business on track for $80 million-plus.
Management highlighted:
- Q3 and Q4 to benefit from compounded refill effect and new account ramp.
- Q4 expected to be the strongest quarter, as in 2024.
Takeaways
Vivi’s trajectory and the Access for All program are the most significant growth drivers in Harrow’s history, with refill compounding and new prescriber adoption tracking ahead of plan. Triessence and IHESO have both moved past Q1 headwinds, with market access and inventory normalization setting up for sequential acceleration. The compounding business remains both a profit center and a strategic pipeline for branded product conversion.
- Vivi’s Prescription Compounding Is the Key Watchpoint: Prescription and refill momentum will determine upside to 2025 guidance as refill stacking amplifies in Q3/Q4.
- Triessence and IHESO Execution Must Deliver: Conversion of new accounts and sustained unit growth are required to meet segment targets.
- Debt Refinancing and Margin Management Remain Near-Term Focus: Successful refinancing and ASP discipline will be critical for valuation and capital flexibility.
Conclusion
Harrow’s Q1 2025 set the stage for a step-change in revenue trajectory as Vivi’s access program and market access wins in Triessence unlock new growth vectors. While Q1 reflected typical seasonal softness and one-time costs, the company’s diversified ophthalmic portfolio and visible commercial levers provide a credible path to exceeding full-year guidance.
Industry Read-Through
Harrow’s success with Vivi’s Access for All program and rapid prescriber expansion is a signal to the broader ophthalmic and specialty pharma sector that patient access initiatives can materially accelerate market share capture and refill compounding. The company’s ability to quickly convert compounding patients to branded products demonstrates the strategic value of vertical integration in specialty pharma. Market access and reimbursement strategy remain the gating factors for adoption in buy-and-bill and specialty brands, with Triessence’s pass-through status providing a template for future launches. Minimal tariff exposure and a focus on domestic sourcing for APIs offer a modest margin buffer relative to peers more exposed to supply chain volatility.