skip to content
Primary navigation


Drug - Eylea® (aflibercept) [Regeneron Pharmaceuticals, Inc.]

April 2020

Therapeutic area - Macular Degeneration Agents

Initial approval criteria

  • Patient is 18 years or older AND
  • Patient is free of ocular and/or peri-ocular infections AND
  • Patient does not have active intraocular inflammation AND
  • Eylea is prescribed by an ophthalmologist AND
  • Therapy will not be used with other ophthalmic VEGF inhibitors AND
  • Patient has a definitive diagnosis of one of the following:
    • Neovascular (Wet) Age-Related Macular Degeneration (AMD)
    • Macular Edema following Retinal Vein Occlusion (RVO)
    • Diabetic Macular Edema (DME)
    • Diabetic Retinopathy (DR)

Renewal criteria

  • Patient continues to meet the criteria identified in section III AND
  • Absence of unacceptable toxicity from the drug. Examples of unacceptable toxicity include the following: endophthalmitis and retinal detachments; increase in intraocular pressure; arterial thromboembolic events AND
  • Patient had a beneficial response to therapy AND
  • Continued administration is necessary for the maintenance treatment of the condition

Quantity limits

  • 2mg per eye every 28 days

Billing for Eylea

Eylea must be billed as a medical claim.


MHCP Provider Call Center 651-431-2700 or 800-366-5411

back to top