XOLAIR Coverage

Benefits Investigations Prior Authorization Starter Program Recertification

Benefits Investigations

XOLAIR Access Solutions can conduct a benefits investigation (BI) to help you determine if XOLAIR is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if financial assistance might be needed.

Potential outcomes of a BI:

Treatment is covered
PA is required
Treatment is denied

Both the Prescriber Service Form and the Patient Consent Form must be received before XOLAIR Access Solutions can begin helping your patient.

These can be downloaded from Forms and Documents or submitted online via My Patient Solutions.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech and Novartis Pharmaceuticals Corporation make no representation or guarantee concerning coverage or reimbursement for any service or item.

Prior Authorization

XOLAIR Access Solutions can help you identify if a prior authorization (PA) is necessary and offer resources as you request it for your patient. Both the Prescriber Service Form and the Patient Consent Form must be received before XOLAIR Access Solutions can begin helping your patient.

If your patient’s request for a PA is not granted, your Field Reimbursement Manager (FRM) or XOLAIR Access Solutions Specialist can work with you to determine your next steps. You can find more tips like this in Forms and Documents.

XOLAIR Starter Program

With the XOLAIR Starter Program, eligible patients taking XOLAIR may receive free medicine while awaiting an insurance coverage determination.

If you think your patient qualifies for the XOLAIR Starter Program, submit the completed Prescriber Service Form and the Respiratory Patient Consent Form to XOLAIR Access Solutions.

Eligible patients experiencing a delay in establishing health insurance coverage, of at least 5 business days, may receive one free 28-day supply of XOLAIR. If a coverage delay persists, the patient may be eligible for one 28-day refill of XOLAIR.

Subject to eligibility requirements and terms and conditions. This program is void where prohibited by law and may not be used in or by residents of restricted states, if applicable.

Recertification

When a medical treatment is authorized for a limited period of time, it will generally require recertification for coverage of continued treatment. XOLAIR Access Solutions can help you obtain recertification for your patients.

If the patient's health insurance plan denies the request for recertification, an appeal may be filed.

If you would like to be sent reminders via fax to recertify your patients for XOLAIR, you can enroll in the XOLAIR Recertification Reminder Program. To enroll, complete the XOLAIR Recertification Reminder Program Enrollment Form.

For assistance, call (877) GENENTECH/(877) 436-3683
6 a.m.–5 p.m. PT, Monday through Friday