Eligible patients may pay as little as a $0 copay for each EYLEA treatment. Subject to annual assistance limit.*

Patient eligibility

  • Must have commercial or private insurance that covers EYLEA
  • Must have a copay for EYLEA
  • Must be a resident of the United States or its territories or possessions
EYLEA copay card. No income eligibility requirement. EYLEA4U® logo.

The EYLEA4U® e-Portal is the one-stop, online destination for reimbursement and patient support.

Program benefits

The program covers*
  • Up to $15,000 in assistance per year toward product-specific copay, coinsurance, and insurance deductibles for EYLEA treatments
The patient is responsible for
  • Any additional copay costs that exceed the program assistance limit
EYLEA pre-filled syringe and packaging.

*Subject to annual assistance limit. 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. 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.

Easy enrollment with the EYLEA Copay Card

To enroll via written form, Copay 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 copay card.

Not an actual Copay Card

For example, if a patient had an out-of-pocket cost of $1,500 for EYLEA (25% coinsurance and $1,000 deductible), the EYLEA Copay Card would cover the $1,500 copay if the patient has not exceeded the $15,000 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, such as Medicare.
  • 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 Copay 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 copay assistance.

Product support for EYLEA® (aflibercept) Injection.
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See More Important Safety Information and Indications
  • CONTRAINDICATIONS: EYLEA 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 INDICATIONS

EYLEA® (aflibercept) Injection 2 mg (0.05 mL) 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).

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.