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

1

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

2

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.