For GA, secondary to AMD

Explore our library of forms and resources

Explore our library of 

forms and resources
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Whether you are looking for an enrollment form, assistance with prior authorization, or help with billing and coding, all resources related to SYFOVRE access and reimbursement can be found here.

Enrollment Forms

Access and Reimbursement Resources 

Practice Resources

Download Enrollment Forms

ApellisAssist® English Enrollment Form

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ApellisAssist® Spanish Enrollment Form

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Download Access and Reimbursement Resources 

Billing and Coding Guide

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J-code Reference Card

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Product Ordering Guide

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Product Fact Sheet

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Access and Reimbursement Guide

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Co-pay Program Resource

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Sample Letter of Medical Necessity

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Sample Letter of Appeals

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Sample Letter of Reauthorization

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FDA Approval Letter

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Practice Resources

SYFOVRE Replacement Programs

Apellis offers replacement programs for SYFOVRE in limited circumstances.
Submit a request below to learn more.a

SUBMIT REQUESTGo to external site

aTerms and conditions apply. Approval of product replacement or supplemental injection kit requests are subject to Apellis program rules, policies, and procedures. Apellis reserves the right, in its 
sole discretion, to amend or discontinue the program at any time and to deny replacement when misuse or abuse is suspected or program eligibility criteria are not met.

AMD=age-related macular degeneration; GA=geographic atrophy.

SYFOVRE® (pegcetacoplan injection) and Access Support Navigator logo lockup

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aEye care professional includes retina specialists, ophthalmologists, optometrists, and office staff working in eye care practices.

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IMPORTANT SAFETY INFORMATION 

INDICATION

CONTRAINDICATIONS

  • SYFOVRE is contraindicated in patients with ocular or periocular infections, in patients with active intraocular inflammation, and in patients with hypersensitivity to pegcetacoplan or any of the excipients in SYFOVRE. Systemic hypersensitivity reactions (e.g., anaphylaxis, rash, urticaria) have occurred.

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

WARNINGS AND PRECAUTIONS

  • Endophthalmitis and Retinal Detachments

    • Intravitreal injections, including those with SYFOVRE, may be associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering SYFOVRE to minimize the risk of endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately.

  • Retinal Vasculitis and/or Retinal Vascular Occlusion

    • Retinal vasculitis and/or retinal vascular occlusion, typically in the presence of intraocular inflammation, have been reported with the use of SYFOVRE. Cases may occur with the first dose of SYFOVRE and may result in severe vision loss. Discontinue treatment with SYFOVRE in patients who develop these events. Patients should be instructed to report any change in vision without delay.

  • Neovascular AMD

    • In clinical trials, use of SYFOVRE was associated with increased rates of neovascular (wet) AMD or choroidal neovascularization (12% when administered monthly, 7% when administered every other month and 3% in the control group) by Month 24. Patients receiving SYFOVRE should be monitored for signs of neovascular AMD. In case anti-Vascular Endothelial Growth Factor (anti-VEGF) is required, it should be given separately from SYFOVRE administration.

  • Intraocular Inflammation

    • In clinical trials, use of SYFOVRE was associated with episodes of intraocular inflammation including: vitritis, vitreal cells, iridocyclitis, uveitis, anterior chamber cells, iritis, and anterior chamber flare. After inflammation resolves, patients may resume treatment with SYFOVRE.

  • Increased Intraocular Pressure

    • Acute increase in IOP may occur within minutes of any intravitreal injection, including with SYFOVRE. Perfusion of the optic nerve head should be monitored following the injection and managed as needed.

ADVERSE REACTIONS

  • Most common adverse reactions (incidence ≥5%) are ocular discomfort, neovascular age-related macular degeneration, vitreous floaters, conjunctival hemorrhage.

INDICATION

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

Please see full Prescribing Information for more information

IMPORTANT SAFETY INFORMATION 

INDICATION

CONTRAINDICATIONS

  • SYFOVRE is contraindicated in patients with ocular or periocular infections, in patients with active intraocular inflammation, and in patients with hypersensitivity to pegcetacoplan or any of the excipients in SYFOVRE. Systemic hypersensitivity reactions (e.g., anaphylaxis, rash, urticaria) have occurred.

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

WARNINGS AND PRECAUTIONS

  • Endophthalmitis and Retinal Detachments

    • Intravitreal injections, including those with SYFOVRE, may be associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering SYFOVRE to minimize the risk of endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately.

  • Retinal Vasculitis and/or Retinal Vascular Occlusion

    • Retinal vasculitis and/or retinal vascular occlusion, typically in the presence of intraocular inflammation, have been reported with the use of SYFOVRE. Cases may occur with the first dose of SYFOVRE and may result in severe vision loss. Discontinue treatment with SYFOVRE in patients who develop these events. Patients should be instructed to report any change in vision without delay.

  • Neovascular AMD

    • In clinical trials, use of SYFOVRE was associated with increased rates of neovascular (wet) AMD or choroidal neovascularization (12% when administered monthly, 7% when administered every other month and 3% in the control group) by Month 24. Patients receiving SYFOVRE should be monitored for signs of neovascular AMD. In case anti-Vascular Endothelial Growth Factor (anti-VEGF) is required, it should be given separately from SYFOVRE administration.

  • Intraocular Inflammation

    • In clinical trials, use of SYFOVRE was associated with episodes of intraocular inflammation including: vitritis, vitreal cells, iridocyclitis, uveitis, anterior chamber cells, iritis, and anterior chamber flare. After inflammation resolves, patients may resume treatment with SYFOVRE.

  • Increased Intraocular Pressure

    • Acute increase in IOP may occur within minutes of any intravitreal injection, including with SYFOVRE. Perfusion of the optic nerve head should be monitored following the injection and managed as needed.

ADVERSE REACTIONS

  • Most common adverse reactions (incidence ≥5%) are ocular discomfort, neovascular age-related macular degeneration, vitreous floaters, conjunctival hemorrhage.

INDICATION

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

Please see full Prescribing Information for more information