Eligible patients may pay only $5 of their co-pay for each EYLEA treatment*

Patient eligibility

  • Must have commercial or private insurance that covers EYLEA for an approved indication
  • Co-pay for EYLEA must exceed $5 per purchase/treatment
    • Must be a resident of the United States or its territories or possessions
EYLEA co-pay card. No income eligibility requirement. EYLEA4U logo

Program benefits

The program covers*
  • Up to $10,000 in assistance per year toward product-specific co-pay, co-insurance, and insurance deductibles for EYLEA treatments
The patient is responsible for
  • The first $5 of each treatment's co-pay
  • Any additional co-pay costs that exceed the program assistance limit
EYLEA vial and packaging

*Not an insurance or debit card program. This program is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA DOD, TRICARE, or similar federal or state programs. The program does not cover or provide support for supplies, procedures, or any physician-related service associated with EYLEA. General, non–product-specific co-pay, co-insurance, 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.

Easy enrollment with the EYLEA Co-Pay Card

To enroll via written form, Co-Pay Assistance should be requested on the Enrollment Form and the form should be submitted via fax (1-888-335-3264) or via the EYLEA4U e-Portal.

To enroll by phone, your office or patients may call EYLEA4U at 1-855-EYLEA4U (1-855-395-3248), Option 4.

EYLEA (aflibercept) Injection co-pay card

Not an actual Co-Pay Card

If a patient had an out-of-pocket cost of $1,500 for EYLEA (25% co-insurance and $1,000 deductible), patient would only be responsible for the first $5.

EYLEA Co-Pay Card would cover the remaining balance of $1,495 if the patient has not exceeded the $10,000 per-year limit. Any cost above the limit would be the patient's responsibility.

  • For patients with insurance not funded through a government healthcare program.
  • A completed and patient-signed form must be retained on file at the office for submissions entered via the e-Portal.

Once a patient's eligibility is confirmed, your EYLEA4U Support Specialist will forward you a confirmation letter and send the EYLEA Co-Pay Card and program terms to your patient.

EYLEA4U logo

EYLEA4U e-Portal: Your one-stop, online destination for reimbursement and patient support

The EYLEA4U e-Portal is an efficient, secure, and convenient tool for enrolling and managing patients in our support programs. The portal is available online for instant access to patient case status updates.§

  • §Requires registration and e-signature setup.

EYLEA4U Enrollment Form

Use the EYLEA4U Enrollment Form to request the specific support your patients need, including co-pay assistance.

Product Support

Find complete product support—guiding you through orders, returns, and more.

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Reimbursement Support

Get help navigating the reimbursement process. Find enrollment forms, sample appeal letters, and more.

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News

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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.