Patient eligibility criteria
- Uninsured or lacks coverage for EYLEA
- Must be a resident of the United States or its territories or possessions
- Must have a completed EYLEA4U® Enrollment Form with patient signature in Section 6.3
Demonstrates financial need
Annual household adjusted gross income (AGI) must satisfy 1 of the following:
- AGI is $100,000 or less
AGI is $100,001–$150,000 AND patient's out-of-pocket drug costs for EYLEA account for ≥3% of patient's AGI
Documentation of patient's out-of-pocket drug costs for EYLEA is required and can 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
- Documentation of patient's out-of-pocket drug costs for EYLEA is required and can include:
- Annual household adjusted gross income (AGI) must satisfy 1 of the following:
Patients are eligible for assistance for up to 1 year and must reapply annually.
EYLEA4U® will independently verify a patient's income with our income validation tool.*
- 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 at any time for audit/verification.
Patient assistance coverage
If a patient is determined to lack coverage for EYLEA through a payer denial and the denial is unsuccessfully appealed, the provider may qualify for a replacement EYLEA vial free of charge.†
EYLEA4U is with you every step of the PAP process
Once the Enrollment Form requesting the PAP is received, a Reimbursement Specialist will:
For questions about applying for coverage, PAP eligibility criteria, or denied claims, call EYLEA4U at 1-855-EYLEA4U (1-855-395-3248), Option 4, Monday–Friday 9 AM–8 PM Eastern Time.
- †Because EYLEA is a physician-administered product with comprehensive insurance coverage, product may be administered to the patient prior to a determination of insurance coverage or eligibility for the PAP. If a patient is denied coverage, and if the denial is unsuccessfully appealed and the patient qualified for the PAP, EYLEA4U will provide the physician with a replacement vial free of charge. Subject to Regeneron policies.