Payer PolicyActive
Eylea, Eylea HD (aflibercept)
EVICORE-MEDICAL_DRUG-894361D9
EviCore by Evernorth
Effective: January 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Eylea and Eylea HD intravitreal injections are covered only for the listed FDA‑approved ophthalmic indications (neovascular AMD, RVO‑related macular edema, DME, DR, ROP) and certain off‑label compendial neovascular ophthalmic conditions. Approval requires documentation of the qualifying diagnosis, administration by or under the supervision of an ophthalmologist, adherence to the indication‑specific dosing schedules, and is authorized for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Neovascular (wet) age-related macular degeneration (AMD)"
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