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STATEMENT OF MEDICAL NECESSITY (SMN) FOR EYLEATM (aflibercept) Injection Phone: 1-855- 4U (1-855-395-3248), Option 4 Section 1.1 Support Requested (check all that apply) Appeals Support Copay Assistance.

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Aug 5, 2011 — 40 mg/mL solution single-use, glass vial (2mg of product) ... Program...
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Contact support

EYLEA4U is a patient support program that offers patient access support, reimbursement support, and product support for your patients who are prescribed ® (aflibercept) Injection. Our dedicated team and wide range of resources can help patients access and answer any questions you might have.

Medicare Part B and Advantage plans may pay for if your doctor says it's a medically necessary treatment for your macular degeneration diagnosis. You or your physician may need to submit documentation detailing the medical necessity to your plan to get approval of the treatment before it's provided.

will run $1,850 per dose, Bloomberg reports, compared with $2,000 for , and $16,000 for a full year, compared with $24,000 for the Roche drug. That discount, compared with , won't put anywhere close to the cost of .

To be eligible to access the Password Protected Areas, you must be a physician or staff member of a physician office that has received a login and password information from the Site.

Moreover, is considered a specialty drug that needs to be obtained from a specialty pharmacy.

The cost for intravitreal solution (40 mg/mL) is around $1,958 for a supply of 0.05 milliliters, depending on the pharmacy you visit.

To report SUSPECTED ADVERSE REACTIONS, contact Regeneron at 1-855-395- 3248 or FDA at 1-800-FDA-1088 or .fda.gov/medwatch.

Co-Pay Card Program: Eligible commercially insured patients may pay as little as $0 per treatment with savings of up to $15,000 per year; for additional information contact the program at 855-395-3248.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232