Medicare and Eylea coverage
Eylea is a brand-name biologic prescription medication containing the active ingredient aflibercept. Generic versions of biologic drugs are called biosimilars. Due to the complex manufacturing process, biosimilar medications are very similar to the original biologic version, but they are not identical. There are currently five biosimilar drugs available for this medication, including:
Unlike the first three biosimilars, the last two — Yesafili (aflibercept-jbvf) and Opuviz (aflibercept-yszy) — are newer options that a new healthcare team
Because a doctor or another healthcare professional administers this medication in their office or clinic, Medicare Part B will cover eligible expenses.
If a person needs take-home medications after receiving Eylea, Part D prescription drug plans will cover eligible expenses. Private insurance companies administer Part D prescription drug plans on Medicare’s behalf, so drug costs and drug availability can vary by plan type and plan provider.
A doctor or another healthcare professional may prescribe Eylea (aflibercept) when medically necessary to slow progressive vision loss from the following conditions:
Medicare Part B covers limited outpatient medications, including those administered in a doctor’s office, hospital outpatient department, or other medical facility. For Eylea (aflibercept), an injection that a doctor administers directly to the eye, coverage will usually be from Part B.
Once a person has paid their Part B plan deductible, which is $257 in 2025, they will be responsible for a 20% coinsurance.
Part D drug plans cover take-home medications that you may need following Eylea (aflibercept).
Not all Part D prescription drug plans have a deductible, but if an individual’s plan does have one, they will join at this stage.
Once a person has paid the plan’s deductible in full, the plan will begin paying its share of eligible costs.
During this stage, people pay a 25% coinsurance toward the cost of Eylea (aflibercept). This applies to both the brand name and generic versions of this and other medications.
In 2025, a person will continue paying the 25% coinsurance until they have paid a total of $2,000. In 2026, this is expected to increase to $2,100.
During this stage, individuals will pay no further costs toward their prescription drugs for the remaining calendar year.
They will receive an explanation of benefits (EOB) the month after their pharmacy bills their plan provider. The EOB will detail the following:
Eylea is a brand-name biologic medication. Its active ingredient is aflibercept. The Food and Drug Administration (FDA) has approved this medication for the treatment of vision loss from:
Eylea (aflibercept) belongs to a group of medications called vascular endothelial growth factor (VEGF) inhibitors. Other drugs in this group are Avastin (bevacizumab) and Lucentis (ranibizumab).
While these three medications work similarly, they are used in different ways. In fact, using Avastin (bevacizumab) for some of the listed eye conditions is specifically considered off-label use. This means the medication is not specifically approved for a condition for which a doctor may use it.
However, each of the three blocks VEGF production, which can cause abnormal blood vessels to grow in a person’s eye, resulting in leaking fluids. By blocking VEGF, these drugs can reduce fluid leakage into the center of an individual’s retina, which is called the macula.