Get the free XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST
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This form is used by prescribers to request preauthorization for Xolair (Omalizumab) for patients with moderate to severe persistent allergic asthma. It requires various patient and physician information
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How to fill out xolair omalizumab preauthorization request
How to fill out XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST
01
Gather patient information, including name, date of birth, and insurance details.
02
Complete the healthcare provider's section, including their name, contact information, and NPI number.
03
Provide a thorough medical history of the patient, including existing conditions and prior treatments.
04
Fill in the specific diagnosis for which XOLAIR is being requested, such as moderate to severe asthma or chronic idiopathic urticaria.
05
Document the patient's previous medications, including any treatments tried and their outcomes.
06
Indicate the proposed treatment plan, including dosage and frequency for XOLAIR.
07
Attach supporting documentation, such as lab results or clinical notes that justify the need for XOLAIR.
08
Review the completed request to ensure all necessary information is included and accurate.
09
Submit the preauthorization request to the patient's insurance company, following their guidelines for submission.
Who needs XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST?
01
Patients diagnosed with moderate to severe asthma who have not responded adequately to other treatments.
02
Individuals suffering from chronic idiopathic urticaria (chronic hives) that have not improved with standard antihistamine therapy.
03
Patients with allergic asthma for whom traditional medications are insufficient.
04
Those with other allergic conditions that XOLAIR is approved to treat and who meet specific clinical criteria.
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People Also Ask about
How to obtain XOLAIR?
Customers can purchase XOLAIR through authorized specialty distributors and wholesalers that have made a commitment to product integrity.
Do I need a prescription for XOLAIR?
A XOLAIR prescription is required for patients with food allergies. *Clinical Education Managers and Contract Nurses are representatives of Genentech and do not give medical advice. Please contact your doctor for medical advice.
How much is XOLAIR injection without insurance?
The list price for Xolair without insurance is $5,000 for adults and about $3,000 for children per month. Most people will not pay the list price. The actual cost will vary based on your insurance coverage. Check your health insurance plan to see if you're covered for Xolair.
Will insurance pay for XOLAIR?
For patients with commercial insurance, about 55% of patients paid $0 out-of-pocket costs per month for XOLAIR. For those patients who did have out-of-pocket costs, 90% paid between $5 to $1,475 per month, after satisfying their deductible. The amount you pay for XOLAIR will depend on your insurance plan.
How do you qualify for XOLAIR?
Moderate-to-Severe Persistent Asthma • Prescriber is an allergist or pulmonologist • Patient is at least 6 years of age • Patient has a diagnosis of asthma • Patient has a positive skin or RAST test to a perennial aeroallergen.
Is omalizumab covered by insurance?
With the XOLAIR Co-pay Program, eligible patients with commercial insurance may pay as little as $0 XOLAIR drug out-of-pocket cost. The program covers up to $15,000 per calendar year benefit period. Note: The final amount owed may be as little as $0, but may vary depending on the health insurance plan.
Does XOLAIR require prior authorization?
Prior authorization (PA) is required for omalizumab (Xolair) prefilled syringe and autoinjector. Requests for omalizumab (Xolair) lyophilized powder for reconstitution will not be considered through the pharmacy benefit.
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What is XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST?
XOLAIR (Omalizumab) preauthorization request is a formal process that healthcare providers must follow to obtain approval from an insurance company to administer XOLAIR, which is used for the treatment of moderate to severe asthma and chronic idiopathic urticaria.
Who is required to file XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST?
Typically, healthcare providers, such as physicians or specialists prescribing XOLAIR for a patient, are required to file the preauthorization request on behalf of the patient.
How to fill out XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST?
To fill out the XOLAIR preauthorization request, the healthcare provider needs to include patient information, medical history, diagnosis, treatment history, and justification for the use of XOLAIR, along with any relevant supporting documentation.
What is the purpose of XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST?
The purpose of the preauthorization request is to ensure that the prescribed treatment with XOLAIR is medically necessary and to secure insurance coverage for the medication.
What information must be reported on XOLAIR (OMALIZUMAB) PREAUTHORIZATION REQUEST?
The information that must be reported includes the patient's personal details, diagnosis codes, previous treatments tried, response to those treatments, and any relevant lab results or documentation supporting the need for XOLAIR.
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