Does Medicare cover Eylea in Ohio?

What Eylea is used for

Eylea is an anti-VEGF drug injected into the eye. Its FDA label covers wet (neovascular) age-related macular degeneration, macular edema after retinal vein occlusion, diabetic macular edema, diabetic retinopathy and retinopathy of prematurity. Eylea HD is a higher-dose version with its own label.

This page explains Medicare coverage only. Questions about whether Eylea is right for you belong with your prescriber.

Which part of Medicare covers Eylea

Medicare.gov explains that Part B usually covers drugs you wouldn't typically give yourself, given in a doctor's office or hospital outpatient department. Eylea fits exactly: the retina practice buys the drug, injects it and bills Medicare for both the drug and the visit. That's why Eylea doesn't appear on Part D formularies the way pills and pens do.

Is Eylea on Medicare's negotiated-price list?

Eylea is not among the drugs CMS has selected for the Medicare Drug Price Negotiation Program so far: the 10 drugs with negotiated prices since January 1, 2026, the 15 with negotiated prices starting January 1, 2027, and the 15 CMS selected on January 27, 2026, for prices that take effect in 2028.

Generics and biosimilars

FDA licensed the first aflibercept biosimilars, which were also rated interchangeable, in May 2024, and has licensed more since; FDA's Purple Book lists them. Your retina specialist decides which product to use; under Part B, coverage of a biosimilar follows the same rules as Eylea.

Eylea in Ohio: Original Medicare, Medigap or Medicare Advantage

Ongoing eye injections are where the choice between Original Medicare and Medicare Advantage shows up most. With Original Medicare you can see any retina specialist who accepts Medicare, but the 20% coinsurance has no yearly limit unless you have Medigap or other coverage. With Medicare Advantage you use the plan's network and may need prior authorization, but in-network costs are capped. Every Ohio county has Medicare Advantage plans open to everyone for 2027, from 22 in Scioto County to 68 in Summit County; check your county.

If you have Medicare Advantage and are thinking about Original Medicare with Medigap so you can see any doctor who takes Medicare, know Ohio's rules first. Ohio has no Medigap birthday or annual switching rule. Your one-time, 6-month Medigap open enrollment period starts when you're both 65 and enrolled in Part B; outside it, and outside a federal guaranteed-issue right, a Medigap company can ask health questions and can turn you down. A bill to add a yearly switching right has been proposed in Ohio; it is not law. If your Medicare Advantage plan is ending in 2027, you have a guaranteed right to buy certain Medigap plans for 63 days after it ends. See Medigap in Ohio and Ohio plans ending in 2027.

What you pay for Eylea under Part B

Part B drug costs work differently from Part D:

• Original Medicare: after the yearly Part B deductible, you generally pay 20% of the Medicare-approved amount for the drug and for the visit. Original Medicare has no yearly out-of-pocket limit.
• Medigap: a Medigap policy can pay some or all of that Part B coinsurance, depending on the plan letter.
• Medicare Advantage: the plan sets its own cost sharing for Part B drugs, and in-network spending is capped by the plan's yearly maximum out-of-pocket limit (no higher than $9,850 in-network in 2027). Plans may require prior authorization or step therapy for Part B drugs.
• Inflation rebates: Medicare.gov notes you may pay lower coinsurance for certain Part B drugs whose prices rise faster than inflation. The list of those drugs changes every quarter.

CMS publishes the 2027 Part B deductible with its yearly Part A and Part B fact sheet; see Medicare costs in 2027. If your income is limited, one of Ohio's Medicare Premium Assistance Programs (the state's name for the Medicare Savings Programs) can help: QMB pays Part B deductibles and coinsurance as well as the premium. See Medicare Savings Programs in Ohio.

The Part D out-of-pocket cap ($2,400 in 2027), the Medicare Prescription Payment Plan and Extra Help apply to Part D drugs, not to Eylea given in your doctor's office.

Checking your coverage for Eylea

1. Confirm your eye doctor takes your coverage. With Original Medicare, ask whether the practice accepts Medicare assignment. With Medicare Advantage, confirm the retina specialist is in the plan's network for 2027.
2. Ask about prior authorization. Medicare Advantage plans may require approval, or a trial of another drug first (step therapy), before covering Eylea. The doctor's office usually handles the request.
3. Know how your coinsurance is paid. Find out whether a Medigap plan, a Medicare Advantage plan's out-of-pocket limit or a Medicare Premium Assistance Program covers your Part B share.
4. Compare before December 7. If you're changing coverage for 2027, look at eye-care networks rather than drug formularies, since Eylea isn't on a Part D formulary. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

Sources

• National Library of Medicine — DailyMed: Eylea prescribing information (FDA label)
• Medicare.gov — Prescription drugs (outpatient) under Part B
• Medicare.gov — Medigap (Medicare Supplement Insurance)
• Ohio Administrative Code — Rule 3901-8-08, Medicare supplement open enrollment and guaranteed issue
• Medicare.gov — Medicare Savings Programs
• FDA — Purple Book: licensed biological products, biosimilars and interchangeables
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
• CMS — Selected drugs for initial price applicability year 2028 (fact sheet, January 2026)
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold, deductible and Extra Help copays)
• CMS — Prescription drug coverage (CY 2027 Landscape files: Ohio is PDP region 14)

Frequently asked questions

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