Eylea (aflibercept) cost per injection and what the patient owes

$722.251 per mg is Part B's ASP+6% rate for Q4 2026. Once the $283 Part B deductible is met, the patient owes the remaining 20% coinsurance on the drug and its administration, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →

Medicare pays J0178 per mg billing unit, not per vial or per treatment session. Eylea's labeled dose is the same 2 mg per eye for every adult indication (wet AMD, diabetic macular edema, diabetic retinopathy and macular edema after retinal vein occlusion), with only the injection schedule changing by indication; retinopathy of prematurity uses a pediatric 0.4 mg dose. The injection itself is always 67028, reported per eye: RT or LT on the line, or once with modifier 50 at 150% when both eyes are injected at the same visit. At the reference one-eye 2 mg dose, the drug alone allows $1,444.50; adding 67028 ($114.23) brings the claim to $1,558.73 allowed, and the patient's 20% coinsurance after the deductible is $311.75.

At a visit where both eyes are treated, the claim carries two drug lines and one procedure line: J0178 for 2 units RT, J0178 for 2 units LT, and 67028 with modifier 50, paid at 150% of the single-eye rate ($171.35 instead of $114.23). Medicare allows $1,444.50 plus $1,444.50 plus $171.35, or $3,060.35, and the patient's 20% coinsurance is $288.90 plus $288.90 plus $34.27, or $612.07.

Avastin (off-label, repackaged bevacizumab, J9035) carries no ASP+6% entry in this quarter's aflibercept pricing file and is omitted from this table. Eylea HD (J0177, an 8 mg dose) is a separate code and is not interchangeable with Eylea on the claim; Pavblu is the FDA-licensed aflibercept biosimilar. Several payers in our coverage corpus name a preferred product ahead of Eylea itself: BCBS Arkansas lists Pavblu and Vabysmo as preferred over Eylea.

For the reference patient (2 mg, one eye, drug + the 67028 injection), Medicare allows $1,558.73, and the Part B coinsurance on that is $311.75. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing per dose once the $283 deductible is met. Plans K and L do not. Because injections come as often as every 4 weeks during the loading phase and no less often than every 8 weeks after that for wet AMD, the deductible column decides most claims within the first two or three doses of the plan year. The dose that lands before the deductible is met costs a Plan K patient $410.57; the dose after it costs $155.87. Unequal charges from one injection to the next, not one recurring number. See what each Medigap plan (A–N) owes on this claim →

Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.

Payers outside Medicare negotiate their own rate for J0178, not ASP+6%. Our corpus holds published rates from all 37 payer files on file, including Aetna, UnitedHealthcare, Cigna, Anthem, Regence, Premera and Kaiser. Aetna’s all-states median is $916 per mg against Medicare’s $722.251, putting the 2 mg per-eye dose at $1,832.00 before benefits. Rates move by state as well as by payer, which is why the estimator above takes one. The 67028 injection procedure carries its own commercial copay or coinsurance separate from the drug line, and EYLEA4U, where the patient is eligible, covers only the drug. What the patient owes then depends on their specific benefits. Full explanation: How commercial drug reimbursement works →

Medicare pays the same ASP+6% rate for the Eylea drug itself no matter where it's given. The 67028 intravitreal injection is reported per eye regardless of which indication is being treated, so the procedure code doesn't change by diagnosis. Intravitreal injections are short in-office procedures typically billed under the physician fee schedule's non-facility rate rather than a hospital-outpatient facility fee. Some commercial payers apply a site-of-care rule to aflibercept; our coverage corpus shows 5 of 28 policy sets carry an explicit site-of-care rule. Our data doesn't carry an Eylea-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.

Place of service (POS) is what drives that rate split. POS 11 (office) prices the admin code at the non-facility physician fee schedule rate, which is the path this estimator prices. A site-of-care rule that sends the same claim to POS 19 (off-campus hospital outpatient), POS 22 (hospital outpatient) or POS 24 (ambulatory surgical center) moves the admin code to the facility rate instead: a different number for the same CPT code. Confirm the POS on the claim before comparing an admin-fee estimate against what a payer actually paid.

The current quarter's payment limit carries three decimal places in the ASP pricing file: $722.251 per mg. The worked examples on this page use that figure; earlier quarters above are shown to two decimals as published. Applied to the same one-eye 2 mg dose, the Q3 2026 rate ($743.605 per mg) allowed $1,487.21 for the drug; the Q4 2026 rate, precise at $722.251, allows $1,444.50. Use the quarter that is actually in effect for the claim's date of service.

On a commercial plan, the EYLEA4U Copay Card can take the drug cost down to $5 per treatment, up to $20,000 a year. It covers the drug only (the 67028 injection procedure is billed and paid separately) and excludes Medicare, Medicaid and other government program patients.

There is a free-drug route from the manufacturer: Regeneron Patient Assistance ships Eylea at no cost to qualifying uninsured patients, at or below 400% of the federal poverty level, but it covers only the drug, not the 67028 procedure or an office-visit fee. On Medicare, neither program applies: EYLEA4U excludes federal program patients by design, and Regeneron Patient Assistance excludes Medicare as well as commercial and Medicaid coverage. Three foundation funds cover macular and retinal disease diagnoses that overlap Eylea's indications: HealthWell Foundation's Macular Degeneration fund (up to $4,000 a year) and Good Days' two retinal-disease funds. All three are closed as of their last status check. Medigap is the only route that reliably reduces the Part B coinsurance on Medicare. See every program for this patient, with current status →

Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (67028, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 37 commercial payer published price files; EYLEA4U Copay Card and Regeneron Patient Assistance terms and status (the site's programs bundle, generated from the live programs corpus).

Reviewed September 20, 2026 by Erin Rose, CareCost Estimate founder. Methodology →