Eligible patients may pay as little as a $0 co-pay for each EYLEA treatment. Subject to annual assistance limit.*
- Must have commercial or private insurance that covers EYLEA
- Must have a co-pay for EYLEA
- Must be a resident of the United States or its territories or possessions
|The program covers*
- Up to $15,000 in assistance per year toward product-specific co-pay, co-insurance, and insurance deductibles for EYLEA treatments
|The patient is responsible for
- Any additional co-pay costs that exceed the program assistance limit
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.
- 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 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.
Important Safety Information
- 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.
- Intravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.
- Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.
- There is a potential risk of arterial thromboembolic events (ATEs) following intravitreal use of VEGF inhibitors, including EYLEA. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported thromboembolic events in wet AMD studies during the first year was 1.8% (32 out of 1824) in the combined group of patients treated with EYLEA compared with 1.5% (9 out of 595) in patients treated with ranibizumab; through 96 weeks, the incidence was 3.3% (60 out of 1824) in the EYLEA group compared with 3.2% (19 out of 595) in the ranibizumab group. The incidence in the DME studies from baseline to week 52 was 3.3% (19 out of 578) in the combined group of patients treated with EYLEA compared with 2.8% (8 out of 287) in the control group; from baseline to week 100, the incidence was 6.4% (37 out of 578) in the combined group of patients treated with EYLEA compared with 4.2% (12 out of 287) in the control group. There were no reported thromboembolic events in the patients treated with EYLEA in the first six months of the RVO studies.
- Serious adverse reactions related to the injection procedure have occurred in <0.1% of intravitreal injections with EYLEA including endophthalmitis and retinal detachment.
- The most common adverse reactions (≥5%) reported in patients receiving EYLEA were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and intraocular pressure increased.
EYLEA® (aflibercept) Injection is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR) in patients with DME.
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.