Help for Uninsured Patients

The Genentech^® Access to Care Foundation (GATCF) was established to help patients who are uninsured—or who have been denied coverage for XOLAIR^® (omalizumab) for subcutaneous use by their health plans. GATCF might be able to help those patients receive XOLAIR treatment if they meet specific financial and medical criteria.

Is my patient eligible?

For your patient to be eligible for help from GATCF, certain specific criteria must be met:

Your patient must have no health insurance or the health plan has denied coverage for XOLAIR
Your patient’s annual household adjusted gross income must be $100,000 or less (special consideration can be given to patients with unique circumstances)
Your patient must meet medical criteria

How do I get started?

To apply to GATCF, you must complete and submit the Statement of Medical Necessity and have your patient complete and submit a Patient Authorization and Notice of Release of Information form.

The Statement of Medical Necessity can be submitted online via My Patient Solutions^™ or downloaded from Forms and Documents.

When completing the Statement of Medical Necessity, be sure to complete all sections of the form.

Once we receive your patient’s information, XOLAIR Access Solutions then contacts the patient within 24 hours with further instructions. This might include verifying financial eligibility.

Additional GATCF program details:

Patients are eligible for free medicine for 1 year and must reapply annually
Patient assistance support may be given before treatment or up to 1 year post-treatment
GATCF assists with the cost of XOLAIR only, not the administration costs

GATCF has the right to modify or end this program at any time and to verify the accuracy of the information you submit.

Important
Safety
Information

FAQs

When should I refer my patient to XOLAIR Access Solutions for help?

At any point after you have prescribed XOLAIR^® (omalizumab), you can refer your patient to XOLAIR Access Solutions. Learn more in See How We Can Help.

Can XOLAIR Access Solutions assist with co-pay issues?

Yes. We may be able to help with co-pay issues in two ways, for both privately and publicly insured patients. Learn more in Find Patient Assistance.

Is there assistance for uninsured patients who have been prescribed XOLAIR?

Yes. The Genentech^® Access to Care Foundation provides help for qualified patients. These include patients who are uninsured or whose health plans have denied payment for XOLAIR. They must meet certain financial and medical requirements. Learn more in Help For Uninsured Patients.

Learn More About
Xolair

LEARN about treatment with XOLAIR
FIND the right patient assistance program with our Compass for Patient Access tool

LEARN HOW the XOLAIR Co-pay Card Program may be able to help with the out-of-pocket costs for XOLAIR

Form Statement of Medical Necessity
Form Patient Authorization and Notice of Release of Information (Current Version)

XOLAIR Indication and Important Safety Information

INDICATION

XOLAIR^®(omalizumab) for subcutaneous use IS INDICATED FOR adults and adolescents (12 years of age and above) with moderate to severe persistent asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids.

XOLAIR has been shown to decrease the incidence of asthma exacerbations in these patients.

Important Limitations of Use

XOLAIR is not indicated for treatment of other allergic conditions
XOLAIR is not indicated for the relief of acute bronchospasm or status asthmaticus
XOLAIR is not indicated for use in pediatric patients less than 12 years of age

Important Safety Information

WARNING: Anaphylaxis Anaphylaxis presenting as bronchospasm, hypotension, syncope, urticaria, and/or angioedema of the throat or tongue, has been reported to occur after administration of XOLAIR. Anaphylaxis has occurred as early as after the first dose of XOLAIR, but also has occurred beyond 1 year after beginning regularly administered treatment. Because of the risk of anaphylaxis, observe patients closely for an appropriate period of time after XOLAIR administration. Health care providers administering XOLAIR should be prepared to manage anaphylaxis that can be life-threatening. Inform patients of the signs and symptoms of anaphylaxis and instruct them to seek immediate medical care should symptoms occur (see Warnings and Precautions: Anaphylaxis).

Malignant neoplasms were observed in 20 of 4127 (0.5%) XOLAIR-treated patients compared with 5 of 2236 (0.2%) control patients in clinical studies of asthma and other allergic disorders.
In patients ≥12 years of age, the most commonly observed adverse reactions (≥1% more frequent in XOLAIR-treated patients) from 4 placebo-controlled asthma studies were arthralgia (8%), pain (general) (7%), leg pain (4%), fatigue (3%), dizziness (3%), fracture (2%), arm pain (2%), pruritus (2%), dermatitis (2%), and earache (2%).
The adverse events most frequently resulting in clinical intervention (e.g., discontinuation of XOLAIR, or the need for concomitant medication to treat an adverse event), in either placebo-controlled or other controlled asthma studies, were injection site reaction (45%), viral infections (23%), upper respiratory tract infection (20%), sinusitis (16%), headache (15%), and pharyngitis (11%). These events were observed at similar rates in XOLAIR-treated patients and control patients.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

Please see full Prescribing Information, including Boxed WARNING and Medication Guide, for additional important safety information.