The EYLEA Copay Card Program

Eligible patients may pay as little as a $0 copay for each EYLEA treatment… up to $15,000 in assistance per year toward product-specific copay, coinsurance, and insurance deductibles for EYLEA treatments.*,†

Patient eligibility

  • Must have commercial or private insurance that covers EYLEA
  • Must be a resident of the United States or its territories or possessions
  • Must be treated with EYLEA for an FDA-approved indication (confirmed with first claim)

No income eligibility requirements.

Nearly 35,000 patients received commercial copay support in 20201

*Not an insurance or debit card program. This program is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, Veterans Affairs, Department of Defense, TRICARE, or similar federal or state programs. This program does not cover or provide support for supplies, procedures, or any physician-related service associated with EYLEA. General, non–product-specific copay, coinsurance, or insurance deductibles are not covered. This program is not valid where prohibited by law, taxed, or restricted. EYLEA4U reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms of use at any time without notice. Additional program conditions apply. See EYLEA.com.

EYLEA4U covers patient out of pockets up to $15,000 per year. Any cost above the $15,000 per-year limit would be the patient’s responsibility.

The EYLEA4U® Patient Assistance Program

The EYLEA4U Patient Assistance Program may be able to provide EYLEA to eligible patients at no cost.

Patient eligibility

  • Must be uninsured or lack coverage for EYLEA
  • Must be a resident of the United States or its territories or possessions
  • Must be enrolled in EYLEA4U
  • Must demonstrate financial need:
    • Adjusted gross income (AGI) ≤$100,000
    • AGI is between $100,001–$150,000 and patient’s out-of-pocket drug costs* for EYLEA account for ≥3% of patient’s AGI
    • Patients are eligible for assistance for up to 1 year and must reapply annually

EYLEA4U Is With You Through Every Step of the Patient Assistance Program Process

An EYLEA4U Reimbursement Specialist is available to:

Verify your patient’s eligibility. EYLEA4U can independently verify your patient’s income with our income validation tool

Notify you of your patient’s eligibility

Send you a confirmation of patient enrollment

Coordinate shipments of EYLEA to your practice

*Documentation of patient’s out-of-pocket drug costs for EYLEA is required and may include: practice receipt of patient payment for EYLEA, which must include the amount paid specifically for EYLEA; practice billing record; or statements showing the patient’s EYLEA drug expenses have been billed.

If the income validation tool is unable to return results, the patient will be required by EYLEA4U to provide proof of income. Proof of income may also be requested any time for audit/verification.

Independent Charitable Foundation Information

Patients who need help paying for their EYLEA out-of-pocket costs can directly apply for financial assistance through independent charitable foundations, including the following*:

Patient Access Network (PAN) Foundation

1-866-316-7263 panfoundation.org

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

Reference
  1. Data on file. Regeneron Pharmaceuticals, Inc. EYLEA4U Lash Database.