XOLAIR Access Solutions offers a range of access and reimbursement resources for your patients and practice after XOLAIR is prescribed, including help with benefits investigations (BIs), resources for prior authorizations (PAs), sample billing and coding information, resources for denials and appeals, information about distribution and referrals to potential financial assistance options.
Get help understanding insurance benefits and coverage, such as with benefits investigations and prior authorization resources.
XOLAIR Access Solutions can conduct a benefits investigation (BI) which can determine:
*If your patient’s request for a prior authorization is not granted, your XOLAIR Access Solutions specialist can work with you to determine your next steps.
Get started with enrollment by following the steps below.
An online tool to help you enroll patients in XOLAIR Access Solutions and manage your service requests at your convenience.
Both forms are required. We must have both the Patient Consent Form and the Prescriber Service Form before we can help you.
What to expect next:
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Patients facing a coverage delay may be eligible for the XOLAIR Starter Program while awaiting insurance verification. If you would like your patient considered for the XOLAIR Starter Program, you can indicate that when enrolling in XOLAIR Access Solutions with the Prescriber Service Form. You will also need to have your patient complete the Patient Consent Form.
Eligible patients can receive up to a 30-day supply of XOLAIR. Once coverage has been determined, the patient no longer qualifies for the XOLAIR Starter Program.
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.
The Genentech Starter Program provides eligible patients who have experienced an insurance coverage delay of 5 business days minimum with up to a 30-day supply of Genentech Starter medicine. If a coverage delay persists, a patient may be eligible for one refill, up to 30-days of Genentech Starter medicine. There is no obligation to purchase any future product and receipt of free product is not contingent on any future purchase. Requests for the Genentech Starter medicine cannot be processed without a completed and signed 1) Product Prescriber Service Form and 2) Patient Consent Form. Patients must be prescribed the Genentech medicine for a valid FDA-approved indication. Neither the prescriber, the pharmacy, nor any patient receiving free Genentech medicine via the Genentech Starter Program may seek reimbursement or credit for any part of the benefit received by the patient through this offer from any insurer, health plan, or government program.
The Genentech Starter Program cannot be counted towards any out-of-pocket costs under any plan (such as true out-of-pocket cost under a Medicare Part D prescription drug plan). The Genentech Starter Program enrollment team may notify the patient’s insurer that the patient is receiving a free supply of product from the Program. Prescribers may not advertise or otherwise use the Program as a means of promoting their services or Genentech’s medicines to patients. This Program is void where prohibited by law and may not be used in or by residents of restricted states, where applicable. The free supply may not be sold, purchased or traded or offered for sale. This Program is not a benefit plan. Genentech reserves the right to rescind, revoke or amend the program without notice at any time.
When a medical treatment is authorized by the patient’s insurance plan for a limited period of time, it will generally require recertification of coverage for continued treatment. XOLAIR Access Solutions can help you obtain recertification for your patients. To opt into recertification, please select the check box on the Prescriber Service Form.
If the patient’s health insurance plan denies the request for recertification, your practice may file an appeal on behalf of your patient.
Sample coding information and resources for denials and appeals
This coding information may assist you as you complete the payer forms for XOLAIR. These tables 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.
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 does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
If your patient’s health insurance plan has issued a denial, your 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:
A sample appeal letter and additional considerations are available on the Practice Forms & Documents page.
Appeals cannot be completed or submitted by Genentech on your behalf.
My Patient Solutions is an online tool to help you enroll patients in XOLAIR Access Solutions and manage your service requests, all through one portal. It allows you the flexibility to work with XOLAIR Access Solutions when it’s convenient for you.
With My Patient Solutions, you can:
How to register
Account registration can be completed by one person for the entire practice and for multiple practice locations. For help with registration or if you have questions, call us at 877-GENENTECH (877-436-3683) (6AM-5PM PST, Monday through Friday).
Genentech has contracted with a network of authorized specialty distributors and specialty pharmacies (SPs) to service practices choosing to prescribe XOLAIR.
These partners have made a commitment to product integrity and have agreed to distribute only products purchased directly from Genentech and not to distribute XOLAIR through secondary channels.
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.
XOLAIR Access Solutions works with specialty pharmacies (SPs) to help patients receive their prescribed Genentech medicines.
In addition to distributing medicines, an SP may provide the following services:
You can work with your preferred SP or contact XOLAIR Access Solutions to learn which SP the patient’s health insurance plan mandates or prefers.
|Absolute Pharmacy Care (Puerto Rico)*||787-892-8700||787-841-1149||N/A
|Accredo Health Group||866-839-2162
|Advocate Aurora Health||888-863-5502||N/A||www.aurorahealthcare.org/services/
|AllianceRx Walgreens Prime||888-347-3416||877-231-8302||www.alliancerxwp.com|
|Ardon Health Specialty Pharmacy||855-425-4085||N/A||www.ardonhealth.com|
|Ascension (The Resource Group)||248-865-3770||N/A||healthcare.ascension.org|
|Avella Specialty Pharmacy||877-546-5779||877-546-5780||www.avella.com|
|Biomatrix Specialty Pharmacy*||877-337-3002||N/A||www.biomatrixsprx.com|
|BioPlus Specialty Pharmacy||888-292-0744||800-269-5493||www.bioplusrx.com|
|CenterWell Specialty Pharmacy||800-486-2668||877-405-7940||www.centerwellpharmacy.com/specialty-medications.html|
|Costco Specialty Pharmacy #570||866-443-0060||N/A||N/A|
|CVS Specialty Pharmacy||800-237-2767||800-323-2445||www.cvscaremarkspecialtyrx.com|
|Elixir Specialty Pharmacy (formerly Envision Rx)||877-437-9012
|Henry Ford (Pharmacy Advantage)*||800-456-2112||248-386-5335||www.pharmacyadvantagerx.com|
|Kroger Specialty Pharmacy (formerly ModernHealth)
|Lumicera Health Services*
|MagellanRx (aka ICORE)*||866-554-2673||866-364-2673||www.magellanhealth.com|
|Maxor Specialty Pharmacy*||866-629-6779||866-217-8034||www.maxor.com|
|Meijer Specialty Pharmacy
|Optum Specialty Pharmacy||855-577-6313||866-876-8966||specialty.optumrx.com|
|Paragon Healthcare Specialty||866-972-5888||866-491-5888||paragonhealthcare.com/specialty-pharmacy|
|Special Care Pharmacy Services (Puerto Rico only)||888-727-1727
|West Virginia University (Allied Health Solutions)||844-988-7216||N/A||wvumedicine.org/allied/specialty-pharmacy|
Genentech does 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. For any product-specific distribution questions, call XOLAIR Access Solutions at 866-422-2377 (6AM-5PM PST, Monday through Friday).
We are serious about patient safety. If your Genentech product is spoiled, expired or damaged, we may be able to help you replace it.
Please contact Genentech Customer Service at 800-551-2231 for any order or return-related questions.
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