EYLEA Co-Pay Card Program

Terms & Conditions:

This program only applies to patients who are at least 18 years of age, residents of the United States or its territories, and are prescribed EYLEA® (aflibercept) Injection for an FDA-approved indication. It is not an insurance benefit, and does not cover or provide support for supplies, procedures, or any physician- related services associated with EYLEA. General, non-product specific co-pay, co-insurance, or insurance deductibles are not covered. EYLEA4U™ reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms of use at any time without notice. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. This offer is not conditioned on any past, present or future purchase, including refills. The copay card is non-transferable, limited to one per person, and cannot be combined with any other offer. This program is not valid where prohibited by law, taxed or restricted. Offer has no cash value.

Patient Instructions: EYLEA must be covered by your commercial insurance. Not valid for cash paying customers. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program. This program is not valid where prohibited by law. By redeeming this coupon, you are certifying that (1) you are not a beneficiary of any government funded program as noted above; (2) should you begin receiving prescription benefits from any government funded program, you will withdraw from this program; and (3) you acknowledge and understand that adherence to the terms and conditions of this offer is necessary to ensure compliance with laws pertaining to any government funded program. In addition, you are certifying that (i) the use of the copay card is not inconsistent with the terms of your arrangement with your insurer or other third-party payer and (ii) you will comply with any obligations to disclose the use of the copay card to any applicable payer. For questions regarding your eligibility or benefits or if you wish to discontinue your participation, please call 1-888-335-3264.


IMPORTANT NOTICE: This program is not valid for prescriptions eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), or other federal or state programs (including any state prescription drug assistance programs). No claim for reimbursement of the out-of-pocket co-pay amount covered by this program may be submitted to any third-party payer, whether public or private. This program cannot be combined with any other rebate/coupon, free trial, or similar offer. This program is not transferable, and is good only in the United States, its territories and possessions. This program is subject to certain eligibility requirements. Regeneron reserves the right to rescind, revoke, or amend this program without notice. By using this program, you understand and agree to comply with the terms and conditions set forth above.

Important Safety Information and Indications
  • 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.
Important Safety Information Important Prescribing Information

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

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.