Product Details

Eylea HD

Aflibercept
8 mg/0.07 mL
Solution for Intravitreal Injection
Single-Use 0.07-mL Vial (Preservative-Free)

DIN/PIN/NPN

02545004

Manufacturer

Bayer Inc., Health Care Division

Formulary Listing Date

2024-12-30  

Unit Price

1250.0000

Amount MOH Pays

1250.0000

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01LA05

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
694 1 year

For the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) in a treatment-naive eye.

Initial diagnosis should be confirmed by an appropriate diagnostic procedure and administration should be done by a qualified ophthalmologist experienced in intravitreal injections.

Patients receiving concurrent administration of other anti-VEGF intravitreal injections are not eligible for reimbursement.

Treatment with anti-VEGF agents should only be continued in patients who maintain adequate response to therapy.

Coverage will be provided for patients responding to therapy with another anti-VEGF agent who switch to Eylea HD. Coverage will not be provided for patients who have failed to respond to other anti-VEGF agents.

Recommended Dose: Treatment should be initiated with a monthly intravitreal injection for the first 3 consecutive doses, followed by one injection every 8 to 16 weeks.

695 1 year

For the treatment of patients with clinically significant diabetic macular edema (DME) for whom laser photocoagulation is also indicated; and a hemoglobin A1c of less than 12 percent.

Patients receiving concurrent administration of other anti-VEGF intravitreal injections are not eligible for reimbursement.

Treatment with anti-VEGF agents should only be continued in patients who maintain adequate response to therapy.

Coverage will be provided for patients responding to therapy with another anti-VEGF agent who switch to Eylea HD. Coverage will not be provided for patients who have failed to respond to other anti-VEGF agents.

Recommended Dose: Treatment should be initiated with a monthly intravitreal injection for the first 3 consecutive doses, followed by one injection every 8 to 16 weeks.

 

EAP Criteria

NO

Product Monograph

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