EYLEA4U Patient Assistance Program

Funded

About

The EYLEA4U Patient Assistance Program provides essential support for patients who need Eylea or Eylea HD but are uninsured or underinsured. This program allows eligible patients to receive Eylea at no cost, providing financial relief and ensuring necessary treatment accessibility. By enrolling in the EYLEA4U Patient Assistance Program, patients can alleviate the financial burden of high drug costs associated with Eylea and Eylea HD, improving their health outcomes.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Eligible uninsured/underinsured patients may be able to receive EYLEA at no cost

•HCP and patient should fax completed enrollment form to 8883353264

•HCP can also register for the EYLEA4U provider portal to upload the information and receive updates (Provider portal: https://www.eylea4ueportal.com/)

•Approved patients are eligible for assistance for up to 1 year and must reapply annually

•For assistance or additional information, call 8553953248, Monday–Friday, 9 AM–8 PM Eastern Time

Enrollment Forms

Enrollment Form