Dosage & Administration Drug label Samples Prior authorization Financial assistance

Xolair

(omalizumab)

0.5 ML omalizumab 150 MG/ML Prefilled Syringe [Xolair]1 ML omalizumab 150 MG/ML Prefilled Syringe [Xolair]

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BLACK BOX WARNING

Dosage & administration

For subcutaneous (SC) administration only.

Divide doses of more than 150 mg among more than one injection site to limit injections to not more than 150 mg per site.

* Asthma: XOLAIR 75 to 375 mg SC every 2 or 4 weeks. Determine dose (mg) and dosing frequency by serum total IgE level (IU/mL), measured before the start of treatment, and body weight (kg). See the dose determination charts.
* Nasal Polyps: XOLAIR 75 to 600 mg SC every 2 or 4 weeks. Determine dose (mg) and dosing frequency by serum total IgE level (IU/mL), measured before the start of treatment, and body weight (kg). See the dose determination charts.
* Chronic Spontaneous Urticaria: XOLAIR 150 or 300 mg SC every 4 weeks. Dosing in CSU is not dependent on serum IgE level or body weight.

drug label

Xolair prescribing information

Have more Xolair questions?

Submit MSL Request

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Need to report a Xolair issue?

ONLINE FORMReport adverse event

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samples

Request Xolair samples

Online Sample Form

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prior authorization

Xolair Prior authorization resources

Complete Letter of Medical Necessity

NOT PROVIDED BY BRANDCoverage Authorization Request

Coverage Authorization Appeals

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Benefits investigation

Xolair Prescriber Service Form

Patient Consent Form - English

Patient Consent Form - Spanish

Prescriber Service Form - Online Portal

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Xolair Financial assistance options

Co-pay savings program

commercial only

Xolair Prescriber Service Form

Patient Consent Form - English

Patient Consent Form - Spanish

Prescriber Service Form - Online Portal

Enroll in Patient Savings Program

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

commercial only

Bridge Program

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

under insured

no insurance

goverment insurance

65+

Xolair Prescriber Service Form

Patient Consent Form - English

Patient Consent Form - Spanish

Prescriber Service Form - Online Portal

Genentech Patient Assistance Foundation Application: Prescriber Form

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement