Aflibercept (Eylea®, Eylea HD® , Pavblu™) Injection

Aflibercept products (Eylea, Eylea HD, Pavblu) are covered only for the policy’s listed FDA‑approved ophthalmic indications (neovascular AMD, RVO macular edema, DME, DR, ROP) and certain compendial off‑label neovascular uses; treatments outside those indications are not supported. Approval (12 months) requires administration by or under the supervision of an ophthalmologist, adherence to product‑ and indication‑specific dosing/frequency limits (e.g., Eylea/Pavblu 2 mg q4 weeks for initial doses then q8 weeks for AMD; Eylea HD 8 mg q4 weeks ×3 then q8–16 weeks; ROP 0.4 mg with ≥10 days between same‑eye doses), and documentation of diagnosis, dosing regimen, and administration dates.

"Other neovascular ophthalmic conditions (approved off-label compendial uses), e."

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