s Eylea » Reimbursement

Navigating the Reimbursement Process

Although EYLEA® (aflibercept) Injection is covered by most payers, it’s important that you understand patient-specific insurance benefits and plan restrictions. Before starting EYLEA treatment, it is recommended that you conduct a Benefits Investigation (BI) by completing and
Male Patient submitting an EYLEA4U® Enrollment Form.

EYLEA4U is here to help you through the entire reimbursement process. We can

  • Provide information on payer requirements for prior authorization
  • Address questions on claims preparation
  • Review the status of a claim with a patient’s insurer
  • Provide information for researching underpaid or denied claims

Understanding Coverage: the First Step in Reimbursement

Determining Coverage

EYLEA4U® helps you determine the coverage available by conducting a Benefits Investigation. To get this started, you must complete the EYLEA4U Enrollment Form. This form authorizes EYLEA4U to perform the support you are requesting.

Click the icon to learn more about filling out the EYLEA4U Enrollment Form:
Fax the Enrollment Form to EYLEA4U at 1-888-335-3264
or submit electronically* via the EYLEA4U e-Portal

*A completed and patient-signed form must be retained on file at the physician’s
office for enrollment submissions entered via the e-Portal.

Understanding the Benefits Investigation Results Report

Understanding the Benefits Investigation Results

This comprehensive report is communicated by fax or via the EYLEA4U® e-Portal within 2 business days of enrollment submission.

Click the icon to learn more:

Prior Authorization

Prior Authorization

Some insurance plans may require a prior authorization before considering coverage for EYLEA® (aflibercept) Injection. If required our Reimbursement Specialists at EYLEA4U® can review and provide information on the prior authorization requirements for that specific payer.

EYLEA4U Is Here to Help

EYLEA4U has 2 programs available to assist eligible patients with certain out-of-pocket costs
  • The Co-Pay Card Program helps qualified patients who have commercial insurance (not funded through a government healthcare program) with certain out-of-pocket co-pay costs
  • Co-Pay Assistance Referral provides qualified patients with referrals to independent co-pay assistance foundations*

*Regeneron does not influence or control the operations of independent co-pay assistance foundations and cannot guarantee assistance will be provided.

Reimbursement Specialists are available Monday–Friday 9 AM–8 PM Eastern Time
to answer any questions. Call 1-855-EYLEA4U (1-855-395-3248), Option 4.

EYLEA4U Benefits Investigation Results

Scroll over each letter for more information

A
Record ID: Patient number assigned by EYLEA4U. Refer to this number when speaking with someone at EYLEA4U
B
Coverage: Indicates patient’s insurance coverage for EYLEA
C
Cost Share: Indicates patient’s financial responsibility
D
Billing Code: Provides suggested billing guidelines from the payer
E
Benefit Summary/Additional Information: Summarizes patient’s coverage, patient’s share of cost, and any additional information about coverage or outcome
F
Product Acquisition Options: Indicates how EYLEA may be acquired. If a specialty pharmacy is an option, EYLEA4U provides the specialty pharmacy options and appropriate contact information

NOTE: This report is not a guarantee of insurance coverage. All benefits are subject to the insured’s plan at the time services are rendered. Under no circumstances shall the EYLEA4U Reimbursement Support Program be held responsible or liable for payment of any claims, benefits, or cost.

Billing and Coding Guidelines for EYLEA® (aflibercept) Injection

Wet Age-related Macular Degeneration (Wet AMD) Billing and Coding Guidelines for EYLEA

The coding information discussed here is provided for informational purposes only, is subject to change, and should not be construed as legal advice. The codes listed below may not apply to all patients or to all health plans; providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services and products furnished to a specific patient.

Use these codes on or after October 1, 2015.
*International Classification of Drugs, 10th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
Macular Edema following Retinal Vein Occlusion (RVO) Billing and Coding Guidelines for EYLEA

The coding information discussed here is provided for informational purposes only, is subject to change, and should not be construed as legal advice. The codes listed below may not apply to all patients or to all health plans; providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services and products furnished to a specific patient.

Use these codes on or after October 1, 2015.
*International Classification of Drugs, 10th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
Diabetic Macular Edema & Diabetic Retinopathy in Patients With DME Billing and Coding Guidelines for EYLEA

The coding information discussed here is provided for informational purposes only, is subject to change, and should not be construed as legal advice. The codes listed below may not apply to all patients or to all health plans; providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services and products furnished to a specific patient.

Use these codes on or after October 1, 2015.
*International Classification of Drugs, 10th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
*International Classification of Drugs, 9th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
*International Classification of Drugs, 9th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
*International Classification of Drugs, 9th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.

Claims and Appeals Support

EYLEA4U® is available to support your office with claims and appeals assistance. If you have questions or need information to prepare a claim, we’re here to help. We can also check the status of an existing claim with the patient’s insurer. Simply contact one of our knowledgeable Reimbursement Specialists.

If you received an underpaid or denied claim for EYLEA, we can provide you with information on how to resolve the issue. We can also research and explain the insurer’s appeal process in detail.

Claims and Appeals Support

EYLEA4U® is available to support your office with claims and appeals assistance. If you have questions or need information to prepare a claim, we’re here to help. We can also check the status of an existing claim with the patient’s insurer. Simply contact one of our knowledgeable Reimbursement Specialists.

If you received an underpaid or denied claim for EYLEA, we can provide you with information on how to resolve the issue. We can also research and explain the insurer’s appeal process in detail.

*International Classification of Drugs, 9th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
*International Classification of Drugs, 9th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
*International Classification of Drugs, 9th Revision, Clinical Modification.
CPT codes, descriptions, and material only are © 2011 American Medical Association. All rights reserved.
Healthcare Common Procedure Coding System (HCPCS).
§ National Drug Code.
Download the Enrollment Form or Sample Claims Forms to Get Started
For more information or help with the reimbursement process, or if you have questions, contact your RBM or EYLEA4U® at 1-855-EYLEA4U (1-855-395-3248), Option 4, Monday-Friday 9AM-8PM Eastern Time
IMPORTANT SAFETY INFORMATION
+
  • EYLEA® (aflibercept) Injection is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.
  • Intravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.
  • Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.
  • There is a potential risk of arterial thromboembolic events (ATEs) following intravitreal use of VEGF inhibitors, including EYLEA. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported thromboembolic events in wet AMD studies during the first year was 1.8% (32 out of 1824) in the combined group of patients treated with EYLEA. The incidence in the DME studies from baseline to week 52 was 3.3% (19 out of 578) in the combined group of patients treated with EYLEA compared with 2.8% (8 out of 287) in the control group; from baseline to week 100, the incidence was 6.4% (37 out of 578) in the combined group of patients treated with EYLEA compared with 4.2% (12 out of 287) in the control group. There were no reported thromboembolic events in the patients treated with EYLEA in the first six months of the RVO studies.
  • Serious adverse reactions related to the injection procedure have occurred in <0.1% of intravitreal injections with EYLEA including endophthalmitis and retinal detachment.
  • The most common adverse reactions (≥5%) reported in patients receiving EYLEA were conjunctival hemorrhage, eye pain, cataract, vitreous floaters, intraocular pressure increased, and vitreous detachment.
IMPORTANT PRESCRIBING INFORMATION

EYLEA® (aflibercept) Injection is indicated for the treatment of patients with

  • Neovascular (Wet) Age-related Macular Degeneration (AMD): The recommended dose is 2 mg administered by intravitreal injection every 4 weeks (monthly) for the first 12 weeks (3 months), followed by 2 mg once every 8 weeks (2 months). Although EYLEA may be dosed as frequently as 2 mg every 4 weeks (monthly), additional efficacy was not demonstrated in most patients when EYLEA was dosed every 4 weeks compared to every 8 weeks. Some patients may need every 4 week (monthly) dosing after the first 12 weeks (3 months).
  • Macular Edema following Retinal Vein Occlusion (RVO): The recommended dose is 2 mg administered by intravitreal injection every 4 weeks (monthly).
  • Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR) in Patients with DME: The recommended dose is 2 mg administered by intravitreal injection every 4 weeks (monthly) for the first 5 injections, followed by 2 mg once every 8 weeks (2 months). Although EYLEA may be dosed as frequently as 2 mg every 4 weeks (monthly), additional efficacy was not demonstrated in most patients when EYLEA was dosed every 4 weeks compared to every 8 weeks. Some patients may need every 4 week (monthly) dosing after the first 20 weeks (5 months).

Please see the full Prescribing Information for EYLEA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

The information provided in this site is intended only for healthcare professionals in the United States. The products discussed herein may have different product labeling in different countries.

EYLEA and EYLEA4U are registered trademarks of Regeneron Pharmaceuticals, Inc.

777 Old Saw Mill River Road, Tarrytown, NY 10591
US-LEA-1934(1)

Share

You are about to leave the EYLEA® (aflibercept) Injection Website
by opening a new page. Regeneron does not control
the content of the Web site connected to this link.

Continue Cancel