XOLAIR Coverage

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 patient assistance might be needed.

Potential outcomes of a BI:

  • Treatment is covered
  • PA is required
  • Treatment is denied

A BI may be initiated once the SMN and PAN are submitted to XOLAIR Access Solutions.

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 obtain it for your patient. PA support may be provided once the SMN and PAN are submitted to XOLAIR Access Solutions.

If your patient’s request for a PA is not granted, your AFRM 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.

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 SMN and PAN to XOLAIR Access Solutions.

Eligible patients can receive XOLAIR for up to 12 weeks. Once coverage has been determined, the patient no longer qualifies for the XOLAIR Starter Program.

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.

PAN=Patient Authorization and Notice of Request for Transmission of Health Information to Genentech Access Solutions and Genentech® Access to Care Foundation.

SMN=Statement of Medical Necessity.