Eylea Medicare Coverage

Eylea is a prescription medication that contains the active ingredient Aflibercept. Eylea is an injection given into the eye every 4 weeks for the first 12 weeks, followed by one injection every 8 weeks.

Eylea should only be administered by an experienced healthcare provider who has appropriate training, experience and knowledge of proper injection technique.

Eylea binds to receptors in the eye and slows vision loss. Eylea is tolerated very well, however a common side effect is seeing floaters.

You cannot fill a prescription for Eylea at a retail pharmacy.

How much does Eylea cost with Medicare?

If Medicare Part B covers Eylea treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Eylea prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare cover Eylea?

Medicare Part B covers injectable and infused drugs administered by a medical provider for qualified beneficiaries.

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Eylea coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Eylea, your Part B benefits will cover Eylea.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Part D plans or Medicare Advantage plans that cover drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2024 Medicare Advantage plans include prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

This medication should be administered by a licensed healthcare provider in a healthcare facility.

If you are taking Eylea, use care when driving or doing other tasks that call for clear eyesight. Have your eye pressure checked by your doctor.

Eylea can increase the risk of health problems caused by blood clots, such as heart attack and stroke.

Immediately report any signs of infection of the eye if you receive this medication. Signs of infection include eye pain or redness, photophobia, and blurred vision.

Do not use Eylea if you are pregnant, because it can harm the unborn baby. Use birth control before starting this drug, during treatment and 3 months after your last dose.  

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.