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 1, then Option 4.
- 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.
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.