Payer PolicyActive
Aflibercept (Eylea)
EVICORE-MEDICAL_DRUG-93BD61E9
EviCore by Evernorth
Effective: December 1, 2018
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Eylea (aflibercept) is covered only for the listed FDA‑approved retinal indications (neovascular AMD, macular edema after RVO, DME, DR with DME) and one approved off‑label compendial use (macular choroidal neovascularization); use for indications not listed is excluded. Approval (up to 12 months) requires documentation of a covered diagnosis, absence of ocular/periocular infection and active intraocular inflammation, and adherence to the indication‑specific intravitreal dosing regimens.
Coverage Criteria Preview
Key requirements from the full policy
"Neovascular (wet) age-related macular degeneration (AMD)"
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