Payer PolicyActive
Aflibercept (Eylea)
EVICORE-MEDICAL_DRUG-1CACFFB5
EviCore by Evernorth
Effective: November 1, 2020
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Eylea (aflibercept) is authorized for FDA‑approved ocular indications (neovascular/wet AMD, macular edema from RVO, DME, DR) and select compendial off‑label neovascular ophthalmic conditions, with other uses not supported. Approvals require documented diagnosis and meeting indication‑specific coverage guidelines, administration by or under an ophthalmologist’s supervision, adherence to the specified dosing schedules (e.g., AMD: 2 mg q4wk ×3 then q8wk; RVO: 2 mg q4wk; DME/DR: 2 mg q4wk ×5 then q8wk), and are issued for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Neovascular (wet) age-related macular degeneration (AMD)"
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