A single injection for wet macular degeneration can cost anywhere from $50 to over $2,600, depending almost entirely on which drug your doctor uses. The most affordable option, bevacizumab (Avastin), runs about $50 to $100 per dose, while newer brand-name drugs like Eylea and Vabysmo range from roughly $1,600 to $2,625 per dose. Since most patients need multiple injections per year, annual costs can add up quickly, but insurance coverage and assistance programs significantly reduce what you actually pay out of pocket.
Cost Per Injection by Drug
Four main drugs are used to treat wet age-related macular degeneration, and their prices vary dramatically. All of them work the same basic way: they block a protein that causes abnormal blood vessels to grow and leak in the back of the eye. The differences come down to how they’re manufactured, how they’re approved, and how often you need them.
Bevacizumab (Avastin) is by far the cheapest option at $50 to $100 per dose. It was originally developed as a cancer drug and is used off-label for eye conditions. A compounding pharmacy splits a single cancer-sized vial into many smaller doses for eye injections, which is why the cost is so low. Despite being off-label, it’s widely used and has been shown in large clinical trials to work just as well as the more expensive alternatives for most patients.
Ranibizumab (Lucentis) was the first drug specifically approved for wet macular degeneration. In 2022, the average Medicare payment per treatment was $1,228.
Aflibercept (Eylea) averaged $1,641 per treatment through Medicare in 2022. A newer, higher-dose version of Eylea carries a wholesale acquisition cost of $2,625 per dose and is designed to extend the time between injections.
Faricimab (Vabysmo) is the newest option, with a list price of $2,234 per dose. It targets two different pathways involved in the disease, which can allow longer intervals between treatments for some patients.
How Many Injections You’ll Need
The total annual cost depends heavily on how often you need treatment. Most patients start with monthly or bimonthly injections. During the first year, that typically means somewhere between 6 and 12 injections, depending on the drug and how your eye responds.
After the initial phase, many doctors use a “treat and extend” approach, gradually spacing out injections as long as the disease stays stable. Some patients settle into a schedule of one injection every 6 to 12 weeks. Research from Johns Hopkins found that up to 30% of patients with wet macular degeneration were eventually able to stop injections altogether, though this required careful monitoring. The remaining patients continued needing treatment on a customized schedule, with some requiring injections indefinitely.
To put total costs in perspective: a patient receiving 8 injections per year of Eylea at the average Medicare payment of $1,641 would face roughly $13,100 in drug costs alone before insurance. That same patient using Avastin at $62 per treatment would face about $500 in drug costs for the year.
What You’ll Actually Pay Out of Pocket
Most patients don’t pay the full price. Medicare Part B covers these injections because they’re administered in a doctor’s office or outpatient setting. After meeting the Part B deductible, you pay 20% of the Medicare-approved amount for both the drug and the doctor’s services. If you receive treatment in a hospital outpatient department, you’ll also pay a separate facility fee.
The doctor’s fee for performing the injection itself is relatively modest. The national average Medicare physician fee is $75 per injection, regardless of the setting. Your 20% share of that comes to about $15.
Where costs diverge is in your coinsurance on the drug. Twenty percent of a $62 Avastin dose is roughly $12. Twenty percent of a $1,641 Eylea dose is about $328. Over the course of a year with multiple injections, that difference adds up to thousands of dollars. If you have a Medicare supplement (Medigap) plan, it may cover some or all of that 20% coinsurance. Medicare Advantage plans have their own cost-sharing structures that vary by plan.
For patients with private insurance, coverage varies, but most plans cover anti-VEGF injections as a medical benefit rather than a pharmacy benefit, meaning they fall under your medical deductible and coinsurance rather than a prescription drug copay.
Manufacturer Assistance Programs
If you have commercial insurance and your out-of-pocket costs are still high, the drug manufacturers offer copay assistance programs that can dramatically reduce your share.
- Eylea Co-Pay Card: Provides up to $10,000 per year toward your copay, coinsurance, and deductibles for Eylea. You pay just the first $5 of each treatment. There’s no income limit. You need to be a U.S. resident with insurance that covers the drug.
- Lucentis Co-Pay Card: Covers your out-of-pocket costs beyond $5 per visit, up to $10,000 per year.
These programs are generally available only to commercially insured patients. If you’re on Medicare or Medicaid, you won’t qualify for copay cards, but you may be eligible for other assistance through nonprofit organizations or state pharmaceutical assistance programs.
Why Your Doctor’s Drug Choice Matters So Much
The price gap between Avastin and the branded alternatives is enormous, and it’s worth understanding why. In 2022, the average Medicare payment per treatment was $62 for Avastin compared to $1,228 for Lucentis and $1,651 for Eylea. Multiple head-to-head clinical trials have found that Avastin performs comparably to Lucentis for most patients with wet macular degeneration.
That said, some doctors prefer the branded drugs for specific clinical reasons: they’re FDA-approved for eye use, they come in pre-filled syringes rather than requiring compounding, and some patients do respond better to one drug over another. The newer drugs like Vabysmo and high-dose Eylea also offer the potential advantage of fewer injections per year, which could offset some of the higher per-dose cost while also meaning fewer office visits and fewer needles in your eye.
If cost is a concern, it’s reasonable to ask your doctor whether Avastin is appropriate for your situation. Many retina specialists use it as a first-line treatment. If your insurance requires a specific drug or your doctor recommends a branded option, ask about copay assistance programs before your first injection so the paperwork is in place when you need it.