Available Financial Assistance Options
The XOLAIR Co-pay Program
If eligible commercially insured patients need assistance with their drug and/or administration out-of-pocket costs, the XOLAIR Co-pay Program may help.
To get started, call (855) 965-2472 or visit XOLAIRCopay.com.
Eligibility criteria and benefit limits apply. Not valid for patients using federal or state government programs to pay for their medicine and/or administration of their Genentech medicine. Patients must be taking the Genentech medicine for an FDA-approved indication. Please visit the Co-pay Program website for the full list of Terms and Conditions.
Referrals to Independent Co-pay Assistance Foundations
For eligible patients with commercial or public health insurance, XOLAIR Access Solutions offers referrals to independent co-pay assistance foundations that may be able to help.
Allergy: Patient Access Network Foundation (PANF) Patient Advocate Foundation (PAF) The Assistance Fund, Inc. The HealthWell Foundation
Dermatology: The HealthWell Foundation
Otolaryngology (Ear/Nose/Throat or ENT) No independent co-pay assistance foundations have been identified at this time.
Independent co-pay assistance foundations have their own rules for eligibility. Genentech and Novartis Pharmaceuticals Corporation have no involvement or influence in independent foundation decision-making or eligibility criteria and does not know if a foundation will be able to help your patient. We can only refer your patient to a foundation that supports their disease state. This information is provided as a resource for you. Genentech and Novartis Pharmaceuticals Corporation do not endorse or show preference for any particular foundation. The foundations in this list may not be the only ones that might be able to help your patient.
The Genentech Patient Foundation
If patients don’t have health insurance coverage or have financial concerns and meet eligibility criteria, they may be able to get Genentech medicine at no cost from the Genentech Patient Foundation.
Call (888) 941-3331 to speak with a live Foundation Specialist. We offer support in many different languages.
To be eligible for free Genentech medicine from the Genentech Patient Foundation, insured patients who have coverage for their medicine should try to pursue other forms of financial assistance, if available, and meet certain income requirements. Uninsured patients and insured patients without coverage for their medicine must meet a different set of income requirements. Genentech reserves the right to modify or discontinue the program at any time and to verify the accuracy of information submitted.
Reimbursement Support
XOLAIR Sample Coding
This coding information may assist you as you complete the payer forms for XOLAIR. These resources are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage.
Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech and Novartis Pharmaceuticals Corporation do not make any representation or guarantee concerning reimbursement or coverage for any item or service.
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Complete and submit a form electronically.
Appeals
If your patient’s health insurance plan has issued a denial, your Field Reimbursement Manager (FRM) or XOLAIR Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.
If a plan issues a denial:
The denial should be reviewed, along with the health insurance plan’s guidelines, to determine what to include in your patient’s appeal submission
Your FRM or XOLAIR Access Solutions Specialist has local payer coverage expertise and can help you determine specific requirements for your patient
A sample appeal letter and additional considerations are available in Resources.
Appeals cannot be completed or submitted by XOLAIR Access Solutions on your behalf.
Coverage Resources
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.
Forms can be downloaded from Enrollment or submitted online via My Patient Solutions®.
A sample appeal letter and additional considerations are available in Resources.
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.
Forms can be downloaded from Enrollment or submitted online via My Patient Solutions®.
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 Resources.
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.
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 Patient Consent Form to XOLAIR Access Solutions.
Forms can be downloaded from Enrollment or submitted online via My Patient 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.
Enrollment
To enroll in Genentech patient support services, both you and your patient will need to complete the required forms.
For Patients: (choose one)
- Patient Consent Form - English
- Patient Consent Form - Spanish
For Providers: (choose one)
- Prescriber Service Form (to enroll patients in XOLAIR Access Solutions)
- Prescriber Foundation Form (to enroll eligible patients into the Genentech Patient Foundation only)
Enroll patients online and manage service requests using My Patient Solutions®
Both forms must be received before Genentech can begin helping your patient. Only the information requested on these forms is required. Providing unrequested documents or information will delay processing.
Distribution
Specialty Pharmacies
XOLAIR Access Solutions works with specialty pharmacies (SPs) to help patients receive their medicines.
An SP may provide the following services:
- Reimbursement resources
- Clinical services to support patients throughout their treatment
- The ability to manage the specialty handling and shipping needs linked with many specialty therapies
You can work with your preferred SP or contact XOLAIR Access Solutions to learn which SP the patient’s health insurance plan requires.
Many SPs are in-network with access to this product. If you are a pharmacy and would like to request product access, please visit our Indirect Access Program website.
Genentech and Novartis Pharmaceuticals Corporation do not influence or advocate the use of any one specialty distributor or SP. We make no representation or guarantee of service or coverage of any item.
Buy and Bill
With buy and bill, the practice purchases the medication in advance, then bills the patient’s health insurance plan for reimbursement. The practice is responsible for storing and handling the drug, as well as collecting the patient’s co-pay for both the drug and its administration. With buy and bill, practices can maintain a stock of the drug, giving them the flexibility to treat patients when clinically appropriate.
Genentech and Novartis Pharmaceuticals Corporation have contracted with a network of authorized specialty distributors to service practices choosing to purchase XOLAIR through the buy and bill model. Customers can purchase XOLAIR through authorized specialty distributors and wholesalers that have made a commitment to product integrity. These partners have agreed to distribute only products purchased directly from Genentech and Novartis AG and not to distribute XOLAIR through secondary channels.
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| Dakota Drug | 866-210-5887 | 763-421-0661 | www.dakdrug.com/ContactUs.aspx |
| DMS Pharmaceutical | 877-788-1100 | 847-518-1105 | www.dmspharma.com/contact-us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| ASD Healthcare (Cencora) | 800-746-6273 | 800-547-9413 | www.asdhealthcare.com |
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Oncology Supply (Cencora) | 800-633-7555 | 800-248-8205 | www.oncologysupply.com/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Cardinal Health Puerto Rico | 787-625-4200 | N/A | cardinalhealth.pr/ |
We work with these authorized distributors and specialty pharmacies to provide XOLAIR to patients and the prescribers.
Genentech and Novartis Pharmaceuticals Corporation do not influence or advocate the use of any one specialty distributor or specialty pharmacy. We make no representation or guarantee of service or coverage of any item.
Spoilage Replacement Program
To learn more about the Genentech Spoilage Replacement Program, click here.