Xolair

Indicated For

allergic asthma, chronic rhinosinusitis with nasal polyps, chronic spontaneous urticaria

About This Medication

# Genentech Patient Foundation Guide: How to Get XOLAIR at Low or No Cost ## About XOLAIR (Omalizumab) XOLAIR is a prescription medication used to treat chronic spontaneous urticaria and other conditions. It's manufactured by Genentech, a leader in biotechnology medicines. If you're struggling to afford XOLAIR, the Genentech Patient Foundation may be able to help you access this medication at little to no cost. ## Who Qualifies for Assistance The Genentech Patient Foundation provides free or reduced-cost XOLAIR to patients who meet specific eligibility criteria. You may qualify if you: - Are uninsured or have financial concerns that make affording XOLAIR difficult - Meet the program's income requirements (see income eligibility section below) - Are 18 years of age or older (or have a legally authorized guardian) - Live in the United States or U.S. Territories - Have a valid prescription from your healthcare provider The program is designed to help patients who lack insurance coverage or who have coverage but face significant out-of-pocket costs for their medication. ## Income Eligibility The Genentech Patient Foundation uses household income to determine eligibility. The income thresholds vary based on your household size and insurance status: | Household Size | Uninsured/Financial Hardship Threshold | |---|---| | 1 person | Less than $75,000 | | 2 people | Less than $100,000 | | 3 people | Less than $125,000 | | 4 people | Less than $150,000 | | Each additional person | Add $25,000 | These thresholds apply to patients without insurance or those experiencing financial hardship. If you have commercial insurance, different income requirements may apply. Contact the Foundation Specialist at 888-941-3331 (Monday–Friday, 6 AM–5 PM PST) to discuss your specific situation. ## Insurance Requirements **Uninsured Patients:** If you have no health insurance, you may be eligible for free XOLAIR through the Genentech Patient Foundation if you meet the income requirements listed above. **Insured Patients with Coverage:** If your insurance plan covers XOLAIR, you should first explore other financial assistance options before applying to the Genentech Patient Foundation. The program is designed primarily for uninsured patients or those without coverage for this specific medication. **Important Note:** The Genentech Patient Foundation does not work with Medicare, Medicaid, or other government insurance programs. If you're enrolled in these programs, you may have other resources available through your plan. **Commercial Insurance Co-Pay Assistance:** If you have commercial insurance and struggle with co-pays, XOLAIR Access Solutions may be able to refer you to independent co-pay assistance foundations to help reduce your out-of-pocket costs. ## What the Program Covers The Genentech Patient Foundation assists with: - The cost of XOLAIR medication - Administration fees for XOLAIR The program does **not** cover: - Other medications or treatments - Office visit fees - Other medical procedures - Administration of other medicines Once you reach the program's maximum annual benefit amount, you'll be responsible for any remaining out-of-pocket expenses. The maximum benefit resets every January 1st. ## Step-by-Step Application Process ### Step 1: Complete the Patient Consent Form Start by filling out the **Patient Consent Form**, which is available in English and Spanish. This form gives Genentech permission to discuss your health information with your doctor and insurance company. You can submit this form in three ways: - Online through the Genentech website - By fax to 833-999-4363 - By text to 650-877-1111 ### Step 2: Notify Your Doctor Once you've completed the Patient Consent Form, contact your doctor's office and let them know you're applying for assistance from the Genentech Patient Foundation. ### Step 3: Your Doctor Completes the Prescriber Foundation Form Your healthcare provider will need to complete the **Prescriber Foundation Form**. This form collects information about your treatment and helps determine your eligibility for the program. Your doctor's office will submit this form along with your Patient Consent Form. ### Step 4: Submit Both Forms **Both forms are required.** No action can be taken until the Genentech Patient Foundation receives both your completed Patient Consent Form and your doctor's completed Prescriber Foundation Form. Submit both forms by: - Fax: 833-999-4363 - Text: 650-877-1111 - Online through My Patient Solutions (if your practice has a registered account) ## Timeline and What to Expect After submitting both required forms, here's what happens next: **Processing Time:** Your application will be processed within **5 business days** of receiving both completed forms. **Notification:** Both you and your healthcare provider will be contacted to discuss the application outcome and any next steps. **Retroactive Coverage:** Once you're enrolled, the program will honor claims with a date of service going back up to **180 days** before your enrollment date. This means you may be reimbursed for XOLAIR costs you've already paid. **Claim Submission Deadline:** Claims must be submitted within 365 days from the date of service. **Delivery:** XOLAIR will be shipped to your physician's office for administration. ## Your Out-of-Pocket Costs Your final cost for XOLAIR through the Genentech Patient Foundation may be as little as **$0**, depending on your specific situation and insurance coverage. The program will cover your out-of-pocket expenses up to the maximum annual benefit amount. Your total out-of-pocket cost depends on: - Your health insurance plan (if you have one) - The program's maximum annual benefit - Your household income and eligibility status ## Ongoing Enrollment and Re-enrollment **Annual Re-enrollment:** If you remain eligible, you'll be automatically re-enrolled in the program every January 1st. **Reauthorization:** If your insurance plan requires recertification of coverage for continued treatment, XOLAIR Access Solutions can help you obtain this recertification. If your insurance denies the request, your doctor's office may file an appeal on your behalf. **Inactivity Policy:** If you don't submit any claims for 3 consecutive years, you'll be removed from the program. You can reapply if you need assistance again. ## What If Your Application Is Denied? If your application for the Genentech Patient Foundation is denied, you have several options: 1. **Review Eligibility Requirements:** Contact a Foundation Specialist at 888-941-3331 to understand why your application was denied and whether you can reapply. 2. **Explore Other Assistance Programs:** If you have commercial insurance, ask about co-pay assistance foundations that may help reduce your out-of-pocket costs. 3. **Discuss with Your Doctor:** Your healthcare provider may have information about other patient assistance programs or resources. 4. **Contact Genentech Access Solutions:** They can provide referrals to other financial assistance options that may be available to you. ## Important Reminders - You must be 18 years or older (or have a legally authorized guardian) to receive assistance - The program is only valid in the United States and U.S. Territories - Program benefits cannot be sold, purchased, traded, or offered for sale - Genentech reserves the right to modify or discontinue the program at any time - All participants must report receipt of program benefits to their insurance company or as required by law ## Contact Information **Genentech Patient Foundation Specialist:** - Phone: 888-941-3331 - Hours: Monday–Friday, 6 AM–5 PM PST - Website: GenentechPatientFoundation.com **For Form Submission:** - Fax: 833-999-4363 - Text: 650-877-1111 ## Disclaimer This guide provides general information about the Genentech Patient Foundation assistance program for XOLAIR. Program eligibility, benefits, and requirements are subject to change at any time. For the most current and complete information, visit GenentechPatientFoundation.com or contact a Foundation Specialist. This information is not a guarantee of eligibility or assistance. Always consult with your healthcare provider about your treatment options and financial assistance programs.

Program information last verified: March 25, 2026