Xolair® Medicare Coverage

Xolair®
Chemical name: Omalizumab

Typical dosage: 150mg

Typical type: Injection1

Xolair® is a medication used to treat allergic, persistent asthma and chronic hives. Xolair is available as a brand name medication and is a subcutaneous injection.

Xolair is a prescription medication that contains the active ingredient Omalizumab. Xolair is an injection given subcutaneously into the fatty part of the skin every 2 to 4 weeks, depending on the condition and the amount of IgE antibodies present before treatment. 

Xolair blocks IgE antibodies from binding which decreases the allergic response in asthma and chronic hives to improve symptoms.

The major side effects associated with Xolair include headache, upset stomach, irritation where the shot is given, feeling tired or weak, nose and throat irritation, signs of a common cold, pain in arms or legs, stomach pain, vomiting and nosebleed.

Does Medicare cover Xolair?

Yes! 98% of Medicare Advantage plans and Medicare Part D plans cover Xolair.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Xolair.

Find Medicare Advantage plans with drug coverage

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

 

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Average costs for Xolair with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$284 – $1,188 $255 – $1,188

Additional information

It may take a few months to see the full effect of Xolair. Do not stop taking this medication without the advice of a doctor. If you are switching to Xolair from a steroid, do not stop taking your steroid abruptly.

Severe allergic reactions have sometimes happened after the first dose, and in some cases over a year after starting treatment with Xolair.

Monitor for signs of an allergic reaction including anxiety, chest or throat tightness, shortness of breath, itching, hives, rash, swelling of the throat or tongue, trouble breathing or swallowing, wheezing or other signs of allergic reaction.

Get emergency medical attention right away if you feel that you’re experiencing an allergic reaction.

Do not use this drug to treat an asthma attack, use a rescue inhaler instead.

Xolair is considered safe during pregnancy and breastfeeding, however, there are risks that should be discussed with your doctor.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.