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Q2 2023
IMPORTANT SAFETY INFORMATION AND INDICATIONS | ||||||||
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Please see additional Important Safety Information below. |
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News and Best Practices
The 2023 EYLEA Market Access National Webcast is available for download |
Click here to listen to the webcast, which provides a review of the EYLEA® (aflibercept) Injection market access landscape, an overview of EYLEA4U® support, and an update on health care policy relevant to the anti-VEGF category. |
The 2022/2023 EYLEA annual reverification is complete! |
In 2023, almost 55,000 EYLEA4U patients had changes to their health insurance benefits: |
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Thank you for your participation in the reverification process and helping to ensure a seamless continuation of EYLEA treatment for your patients. |
Navigating Payer Challenges (NPC) refresh |

The NPC resource contains information for HCPs and office administrators that may facilitate how to access, submit claims, and seek reimbursement in order to secure their patients’ access to EYLEA. Flash cards on specific state, US territory, and other ancillary insurance laws, rules, and regulations have been updated. |
In addition to obtaining these flash cards from your Reimbursement Business Manager (RBM), you can also visit NavigatingPayerChallenges.com, a new website where you can: |
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We suggest you bookmark the website for your convenience. We will update the information on a regular basis. |
JZ modifier to be required on Medicare Part B claims for EYLEA |
Beginning July 1, 2023, HCPs will be required to report the JZ modifier when submitting Medicare Part B claims from all outpatient settings. The JZ modifier is an HCPCS Level II modifier reported on a claim that is used to attest that no amount of drug was discarded and eligible for payment and that no JW modifier amount is reported (a JW modifier is required when indicating that the discarded drug was not administered to a patient). Like the JW modifier, the JZ modifier should only be used for claims that bill for single-dose container drugs as approved by the FDA. As of October 1, 2023, claims for drugs from single-dose containers that do not use the JW and JZ modifiers appropriately may be returned.2 |
Click here to learn more. |
In other news… |
UnitedHealthcare 2023 changes |
For Medicare Advantage patients: |
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For commercial patients: |
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EYLEA4U® Updates
Commercial Copay Program | |||||
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Patient Assistance Program (PAP) Updates | |||||||||||
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* | As of December 19, 2022, all patients enrolled in the EYLEA Commercial Copay Card Program will have a product benefit cap of $20,000 (up from the current $15,000 max annual benefit per Program enrollee) for J0178 through their eligibility end date. Additionally, starting December 19, 2022, patients enrolled in the Program will have an administration benefit cap of $1,000 for 67028 in association with their EYLEA treatment through their eligibility end date. |
† | Not an insurance or debit card program. This program is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, Veterans Affairs, Department of Defense, TRICARE, or similar federal or state programs. This program does not cover or provide support for supplies for EYLEA. This program is not valid where prohibited by law, taxed, or restricted. Patients who are residents of Massachusetts or Rhode Island are not eligible for EYLEA administration assistance. EYLEA4U reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms of use at any time without notice. Additional program conditions apply. See EYLEA.com. |
National Access Spotlight
Preferred Access
EYLEA is now the preferred branded anti-VEGF agent for UnitedHealthcare Medicare Advantage patients and continues to be a preferred agent for Anthem Commercial and Medicare Advantage patients.
(DME, DR, MEfRVO indications)
75% of all covered lives will have first-line access to EYLEA with no step edits.5
Unrestricted Access to EYLEA
No PA or step edit required.
Parity Access to Bevacizumab
EYLEA is covered without a step edit for UnitedHealthcare Commercial.‡
(all indications)
Step Edit Policies
Step edit policies are in place for these select health plans.‡
(Step edit is for Wet AMD indication only)
Patients in plans with step edits make up 25% of all patients receiving EYLEA nationally. Of health plans that require step edits, 88% of them allow EYLEA to be used after 1 injection of bevacizumab.5
UnitedHealthcare PA Portal Update
Click here for information about a PA update on UnitedHealthcare’s medical benefit specialty injectable drug programs and PA tools
Local Access
Ask your RBM for a Payer Business Review for your specific location.
Your RBM can provide a local review of your payer landscape and answer questions related to coverage of EYLEA in your specific location. Your RBM can also provide state-specific information and an overview resource of several laws and regulations that may apply to patient insurance and payer issues.
‡ | Individual patient coverage may vary by health plan. Contact the patient’s health plan for the most current coverage information. |
This information is provided for informational purposes only, is subject to change, and should not be construed as legal or medical advice. This information may not apply to all patients or to all health plans and providers should exercise independent judgment when submitting claims.
CMS Policy Pulse
Stay up-to-date with the latest information on audits from CMS
Current Medicare Administrative Contractor (MAC) Medical Review List
Product Support
Click here for a list of authorized specialty distributors and specialty pharmacy providers for EYLEA.
Regeneron does not recommend the use of any particular authorized distributor or specialty pharmacy.
Resources
Your dedicated RBM can provide support to help your eligible patients access EYLEA. They provide support in areas including access and reimbursement, financial assistance, and health plan policy, and can provide you with various educational tools and resources. | ||||||||||||||||||||||||||||||||||||||
Contact your RBM to learn more about the latest tools and resources available for EYLEA: | ||||||||||||||||||||||||||||||||||||||
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New resources for Retinopathy of Prematurity (ROP) indication | ||||||||||||||||||||||||||||||||||||||
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IMPORTANT SAFETY INFORMATION AND INDICATIONS | ||||||||||
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Please see the full Prescribing Information for EYLEA. | ||||||||||
AMD = age-related macular degeneration; CMS = Centers for Medicare & Medicaid Services; DME = diabetic macular edema; DR = diabetic retinopathy; ERISA = Employee Retirement Income Security Act; FDA = US Food and Drug Administration; HCP = health care provider; HCPCS = Healthcare Common Procedure Coding System; ICD-10-CM = International Classification of Diseases, Tenth Revision, Clinical Modification; MEfRVO = macular edema following retinal vein occlusion; NDC = National Drug Code; PA = prior authorization; RBM = Reimbursement Business Manager; TPE = Targeted Probe and Educate; VEGF = vascular endothelial growth factor. | ||||||||||
For Colorado Prescribers — Click Here for Pricing Information | ||||||||||
References 1. Robeznieks A. New physician “gold card” law will cut prior authorization delays. American Medical Association. Published September 15, 2021. Accessed April 1, 2023. https://www.ama-assn.org/practice-management/prior-authorization/new-physician-gold-card-law-will-cut-prior-authorization 2. Medicare program: discarded drugs and biologicals—JW modifier and JZ modifier policy. Frequently asked questions. Accessed March 22, 2023. https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf 3. Medicare Part B Step Therapy Programs. UnitedHealthcare. Effective March 22, 2023. Accessed March 22, 2023. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-coverage-sum/medicare-part-b-step-therapy-programs.pdf 4. Ophthalmologic Policy: Vascular Endothelial Growth Factor (VEGF) Inhibitors. UnitedHealthcare Commercial Medical Benefit Drug Policy. UnitedHealthcare. Effective December 1, 2022. Accessed March 22, 2023. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/ophthalmologic-vegf-inhibitors.pdf 5. Data on file. Regeneron Pharmaceuticals, Inc. |