Is Syfovre covered by Medicare?

Medicare Part B covers the retina disease treatment Syfovre if you have geographic atrophy (GA) secondary to age-related macular degeneration (AMD). After you meet your Part B deductible, your cost is 20% of the Medicare-approved amount for the drug and services.

Medicare Part B helps cover outpatient services from doctors and other healthcare professionals. Your costs may vary depending upon if you have insurance copays or deductibles, your Medicare coverage, and how much your doctor charges. Check with your Medicare plan for coverage details.

To find out how much Syfovre will cost, talk to your health care provider and insurance carrier.

How much you’ll owe may depend on:

• Your Medicare benefit plan
• Additional Medicare supplemental insurance you may have
• Any doctor’s fees or facility charges
• If you have met your deductible or are in a coverage gap

If you are having trouble affording your medicine, call Apellis Pharmaceuticals at 1-888-APELLIS (1-88-273-5547) ET. Monday - Friday. They may be able to offer financial information or assistance.

What is Syfovre?

Syfovre (pegcetacoplan) is a medicine injected into the eye to treat geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Syfovre helps to slow the growth of GA lesions and preserve vision by reducing vision loss and blindness.

Syfovre is administered via intravitreal injection (into the back of your eye) once every 25 to 60 days, usually in your doctor’s office or clinic. Your retina specialist will numb your eye first. A doctor who treats age-related macular degeneration (AMD) and geographic atrophy (GA) are known as a retina specialist (an ophthalmologist).

What is Geographic Atrophy?

Geographic atrophy (GA) is a progressive and irreversible form of dry age-related macular degeneration (AMD) and is a leading cause of blindness. In GA, cell death in areas of the retina may result in dim or dark spots in the central vision.

While GA cannot be cured, treatment can slow lesion growth and disease progression

It affects more than 1 million people in the U.S. and 5 million people worldwide.

How well does Syfovre work?

In the 24-month OAKS and DERBY Phase 3 studies, Syfovre demonstrated a slowing in the growth of lesions (areas of retinal cell loss).

In the OAKS trial (with 637 participants), monthly injections slowed GA lesion growth by 22%, and every-other-month injections slowed GA lesion growth by 18%.
In the DERBY trial (with 621 participants), monthly injections slowed lesion growth by 18%, and every-other-month injections slowed lesion growth by 17%.

The most common side effects with Syfovre include:

• ocular (eye) discomfort
• neovascular age-related macular degeneration
• vitreous floaters
• conjunctival hemorrhage.

Syfovre is contraindicated in patients with ocular or periocular infections, and in patients with active intraocular inflammation.

Related questions

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How much does Syfovre cost?

The cost for Syfovre is around $2,316 for a supply of 0.1 mL (15 mg / 0.1 mL), which is the recommended dose. It is administered by intravitreal injection to each affected eye once every 25 to 60 days.

Syfovre is a medicine that will be given to you by your healthcare provider in their office or clinic, usually on an outpatient basis. You will not typically pay for this medicine directly, but will most likely be billed for your portion (after insurance) by your healthcare provider.

Syfovre is available as a brand name drug only, a generic version is not yet available.

For more information about Syfovre price, copay programs and patient financial assistance visit the drugclasses.com Syfovre Price Guide.

What is Medicare?

Medicare (Part A and Part B) is the U.S. medical insurance plan for people 65 years and older. Part D is a separate prescription drug plan bought individually. You can also buy a Medigap (supplemental) plan to help pay for extra out-of-pocket costs.

Medicare Advantage plans (also called “Part C”) include hospital coverage through Medicare Part A, medical and outpatient insurance through Part B, and prescription drug coverage through Part D. Private insurance companies that contract with Medicare offer these plans. These plans include Part A, Part B, and usually Part D.

In certain Medicare Advantage plans, extra benefits may be offered, such as dental, vision or hearing aid benefits.

Your copays and deductibles for your Medicare Advantage Plan will depend upon your plan benefits.

This is not all the information you need to know about Syfovre (pegcetacoplan) for safe and effective use and does not take the place of your healthcare provider's directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.