Eylea and cost

As with all medications, the cost of Eylea can vary. Factors that may affect the price you’ll pay include:

• your treatment plan
• your insurance coverage
• the cost of the visit to your doctor to receive doses of Eylea
• whether Eylea has a savings program (see the “Financial and insurance assistance” section below)

To find out what the cost of Eylea will be for you, talk with your doctor or insurance provider.

Insurance considerations

Below is information you may want to consider if you have insurance and receive Eylea.

Prior authorization. If you have insurance, your insurance company may require prior authorization before it covers Eylea. This means the company and your doctor will discuss Eylea in regard to your treatment. The insurance company will then determine whether to cover the medication. If a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Eylea requires prior authorization.

Type of insurance coverage. Eylea is given by your doctor. If you have insurance, the price of your Eylea doses may be billed through your medical coverage instead of the prescription drug portion of your insurance plan. This depends on your specific insurance plan and where you receive your Eylea doses, such as at your doctor’s office. If you have questions about this process, contact your doctor or your insurance provider.

Here are answers to some frequently asked questions about drug cost and Eylea.

Does Eylea cost less than Avastin?

Eylea may cost more than Avastin. Similar to Eylea, Avastin is prescribed to treat certain conditions of the eye. However, what you’ll pay for either drug depends on several factors. One is whether you use insurance and the type of plan you have. Other factors include the cost of the visit to receive the drug and whether it has a savings program.

To determine the cost of Eylea compared with Avastin with insurance, you’ll need to contact your insurance plan provider. If you don’t use insurance, talk with your doctor. They can help you find ways to save on the cost of Eylea. You can also refer to the “Financial and insurance assistance” section below.

Is Eylea covered by Medicare?

Eylea may be covered by Medicare. For example, Medicare Part B typically covers medications that are given in a doctor’s office or another healthcare setting. Since Eylea is given in a healthcare setting, Medicare may cover it. However, you’ll need to contact Medicare or your individual plan provider (if you have one) to find out what you’ll pay for Eylea.

Keep in mind that you may owe a deductible or coinsurance payment for Medicare Part B services, including receiving Eylea injections.

To learn more about Medicare, see the “Next steps” section below.

Eylea contains the active ingredient aflibercept, and it’s available only as a brand-name biologic drug. It doesn’t come in a biosimilar version. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Also, biosimilars tend to cost less than brand-name medications.

WHY ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?

Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to 12 years. When the biologic drug’s patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don’t require the same costly testing.

If you need financial support to pay for Eylea, or if you need help understanding your insurance coverage, help is available. For example:

• A program called EYLEA4U is available for Eylea. For more information and to find out if you’re eligible for support, call 855-395-3248 or visit the program website.
• Some websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are:
  • Medicine Assistance Tool
  • NeedyMeds

To learn more about saving money on prescriptions with or without insurance, check out this article.

Now that you’ve learned about cost and Eylea, you may still have some questions. Talk with your doctor, who can provide personalized guidance about cost issues related to Eylea. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Eylea.

Here are some other resources you may find helpful:

• Medicare drug coverage. To learn about Medicare coverage for drugs, see these articles about Medicare prescription drug plans, drug coupons and Medicare, and the Medicare drug list.
• More details. For details about other aspects of Eylea, refer to this article.
• Side effects. For details about Eylea’s side effects, see this article. You can also look at the Eylea prescribing information.
• Drug comparison. Find out how Eylea compares with Avastin and Lucentis.
• Information about your condition. For more information about your condition, see our list of eye health and blindness articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.