Xolair Starter Program

Funded

About

The Xolair Starter Program offers an essential support mechanism for patients prescribed Xolair who are experiencing delays in insurance coverage. This program ensures that eligible patients who face a delay of at least 5 business days in health insurance coverage can receive a free initial supply of Xolair. The Xolair Starter Program is particularly beneficial for those with private or commercial insurance, guaranteeing timely access to this specialized drug product, while facilitating subsequent refills under specific conditions.

Insurance requirements: Commercially insured, Medicare / Medicaid

Enrollment Forms

Enrollment Form

Benefits

•2 maximum fills per year

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible patients experiencing a delay in establishing health insurance coverage of at least 5 business days may receive one free 28day supply of XOLAIR

•If a coverage delay persists, the patient may be eligible for one 28day refill of XOLAIR

•If HCP thinks patient qualifies for the XOLAIR Starter Program, submit the completed Prescriber Service Form and the Respiratory Patient Consent Form to XOLAIR Access Solutions

•Respiratory Patient Consent Form is located here: https://www.genentechaccess.com/content/dam/gene/accesssolutions/pdfs/patientconsentform/GenentechAccessSolutionsPatientConsent_Form.pdf

•For assistance, call (877) 4363683 6 a.m.–5 p.m. PT, Monday through Friday

Enrollment Forms

Enrollment Form