Enrolling in EYLEA4U, the Patient Support Program for EYLEA, Is the First Step to Unlocking Support for You and Your Patients

There are 3 ways to enroll in EYLEA4U.

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Download the enrollment form here and provide all required information

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Visit EYLEA4Ueportal.com and proceed to the Registration Information page

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Enroll through EYLEA4U Connect via the portal or tablet-based technology*

*Requires the use of a tablet provided by Regeneron’s third-party technology source and a license paid for by the HCP office.

EYLEA4U Connect:
A Streamlined Electronic Enrollment Process That Can Connect Patients to All EYLEA4U Support Services*

EYLEA4U Connect is available 24 hours a day, 7 days a week for enrollment and instant confirmation messaging.

More than 40% of patients receive a benefit verification within 60 seconds with EYLEA4U Connect

EYLEA4U Connect Core Capabilities

  • Ability to enroll patients in EYLEA4U online
  • Potential for full benefit verification within 60 seconds
  • Ability to reverify medical insurance status of an enrolled patient who has previously completed a benefit verification
  • Alert notifications on specific patient support requests
  • Faster enrollment in EYLEA4U
  • Potential for faster time to treatment

*Program terms and conditions apply.

Within 60 seconds, EYLEA4U will provide either a full benefit verification or notification that manual processing is required. Of the patients who received a benefit verification through EYLEA4U as of January 2020, over 40% received a full benefit verification report within 60 seconds. Manual processing may take up to 48 hours.

A completed and patient-signed EYLEA4U Enrollment Form must be retained on file at your office.

Accessing EYLEA4U Connect

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On a computer, via the portal


Go to EYLEA4Ueportal.com. Bookmark the page for easy reference


Click Register Now. You will be directed to the Registration Information page

EYLEA4U will contact you directly to validate your account within 2 days of registering. For immediate verification of your account, contact Web Support at 1-855-EYLEA4U (1-855-395-3248), Option 4, Monday–Friday, 9 AM–8 PM Eastern Time.

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Via tablet-based technology*

Tablet-based technology that interfaces with electronic medical record, practice management, and inventory management system technology and can connect patients to all EYLEA4U support services

  • Electronic signature capture for tablet enrollment
  • Electronic submissions in real time
  • Electronic enrollment solutions can offer benefit verification accuracy

Contact your Reimbursement Business Manager if you are interested in utilizing the tablet.

*Requires the use of a tablet provided by Regeneron’s third-party technology source and a license paid for by the HCP office.

For tablet only; portal enrollment requires patient signature to be filed.