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Welcome to the XOLAIR Co-pay Card Program

The XOLAIR Co-pay Card Program can help patients with their co-pay for XOLAIR, if they qualify. Patients participating in this program pay $5 per drug co-pay. In addition, the total co-pay assistance is up to $10,000 per 12-month period.

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Eligibility

Eligible patients:

  • Are taking XOLAIR for an approved use
  • Get XOLAIR through:
    • A XOLAIR specialty pharmacy
    • A doctor's office
    • An alternate injection center (AIC)
    • A hospital outpatient department (HOPD)
  • Are 18 years of age or older
    • If you are under the age of 18, a legal guardian must manage the card
  • Are not getting help from the Genentech® Access to Care Foundation (GATCF) or any other charitable organization
  • Do not have a state or federal healthcare plan. This includes, but is not limited to, Medicare, Medicaid and TRICARE

XOLAIR Co-pay Card Program Terms and Conditions

  • By using the XOLAIR Co-pay Card Program, the patient acknowledges and confirms that at the time of usage, (s)he is currently eligible and meets the criteria set forth in the terms and conditions described
  • The XOLAIR Co-pay Card provides drug co-pay assistance for eligible patients. Once enrolled, eligible patients pay $5 per drug co-pay until a maximum of $10,000 of co-pay assistance per 12-month period is reached
  • The XOLAIR Co-pay Card is valid ONLY for patients with commercial (private or non-governmental) insurance
  • Patients using Medicare, Medicaid or any other government funded program to pay for their medications are not eligible. Patients who start utilizing their Government coverage during their enrollment period will no longer be eligible for the program
  • The XOLAIR Co-pay Card Program is not health insurance or a benefit plan
  • Distribution or use of the XOLAIR Co-pay Card does not obligate use of or continuing use of any specific product or provider
  • Patient or guardian is responsible for reporting the receipt of all XOLAIR Co-pay Card Program assistance or reimbursement received, to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the XOLAIR Co-pay Card Program, as may be required
  • The XOLAIR Co-pay Card is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as: GATCF or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her medication
  • Patient, guardian, pharmacist, prescriber and any other person using the XOLAIR Co-pay Card agree not to seek reimbursement for all or any part of the assistance received by the recipient through the offer
  • The XOLAIR Co-pay Card will be accepted by participating specialty pharmacies, physician offices or hospitals
  • To qualify for the XOLAIR Co-pay Card Program, the patient may be required to pay out-of-pocket expenses for each treatment. Once enrolled, the XOLAIR Co-pay Card Program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 120 days
  • This XOLAIR Co-pay Card is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription
  • Use of this XOLAIR Co-pay Card must be consistent with all relevant health insurance requirements and payer agreements
  • Participating patients, pharmacies, physician offices and hospitals are obligated to inform third-party payers about the use of the XOLAIR Co-pay Card as provided for under the applicable insurance or as otherwise required by contract or law
  • The XOLAIR Co-pay Card may not be sold, purchased, traded or offered for sale, purchase or trade
  • The XOLAIR Co-pay Card is limited to 1 per person during this offering period and is not transferable
  • The XOLAIR Co-pay Card expires within 12 months from enrollment
  • This program is not valid where prohibited by law
  • For Massachusetts' residents, this program shall expire on or before July 1, 2019
  • The patient or their guardian must be 18 years or older to receive XOLAIR Co-pay Card Program assistance
  • This Co-pay Card Program is:
    • Void if the card is reproduced
    • Void where prohibited by law
    • Only valid in the United States and Puerto Rico
    • Only valid for XOLAIR
    • Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or either company's products to patients
    • Genentech, Inc. and Novartis Pharmaceuticals Corporation reserve the right to rescind, revoke, or amend the program without notice at any time

What is XOLAIR?

XOLAIR® (omalizumab) for subcutaneous use is an injectable prescription medicine used to treat:

  • moderate to severe persistent asthma in patients 6 years of age or older whose asthma symptoms are not controlled by asthma medicines called inhaled corticosteroids. A skin or blood test is performed to see if you have allergies to year-round allergens.
  • chronic idiopathic urticaria (CIU; chronic hives without a known cause) in patients 12 years of age and older who continue to have hives that are not controlled by H1 antihistamine treatment.

XOLAIR is not used to treat other allergic conditions, other forms of urticaria, acute bronchospasm or status asthmaticus.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about XOLAIR?

Severe allergic reaction. A severe allergic reaction called anaphylaxis can happen when you receive XOLAIR. The reaction can occur after the first dose, or after many doses. It may also occur right after a XOLAIR injection or days later. Anaphylaxis is a life-threatening condition and can lead to death. Go to the nearest emergency room right away if you have any of these symptoms of an allergic reaction:

  • wheezing, shortness of breath, cough, chest tightness, or trouble breathing
  • low blood pressure, dizziness, fainting, rapid or weak heartbeat, anxiety, or feeling of “impending doom”
  • flushing, itching, hives, or feeling warm
  • swelling of the throat or tongue, throat tightness, hoarse voice, or trouble swallowing

Your healthcare provider will monitor you closely for symptoms of an allergic reaction while you are receiving XOLAIR and for a period of time after your injection. Your healthcare provider should talk to you about getting medical treatment if you have symptoms of an allergic reaction after leaving the healthcare provider´s office or treatment center.

Do not receive XOLAIR if you are allergic to omalizumab or any of the ingredients in XOLAIR.

Before receiving XOLAIR, tell your healthcare provider about all of your medical conditions, including if you:

  • have any other allergies (such as food allergy or seasonal allergies)
  • have sudden breathing problems (bronchospasm)
  • have ever had a severe allergic reaction called anaphylaxis
  • have or have had a parasitic infection
  • have or have had cancer
  • are pregnant or plan to become pregnant. It is not known if XOLAIR may harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if XOLAIR passes into your breast milk. Talk with your healthcare provider about the best way to feed your baby while you receive XOLAIR.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, or herbal supplements.

How should I receive XOLAIR?

  • XOLAIR should be given by your healthcare provider, in a healthcare setting.
  • XOLAIR is given in 1 or more injections under the skin (subcutaneous), 1 time every 2 or 4 weeks.
  • In asthma patients, a blood test for a substance called IgE must be performed prior to starting XOLAIR to determine the appropriate dose and dosing frequency.
  • In patients with chronic hives, a blood test is not necessary to determine the dose or dosing frequency.
  • Do not decrease or stop taking any of your other asthma or hive medicine unless your healthcare providers tell you to.
  • You may not see improvement in your symptoms right away after XOLAIR treatment.

What are the possible side effects of XOLAIR?

XOLAIR may cause serious side effects, including:

  • See, “What is the most important information I should know about XOLAIR” regarding the risk of anaphylaxis.
  • Cancer. Cases of cancer were observed in some people who received XOLAIR.
  • Inflammation of your blood vessels. Rarely, this can happen in people with asthma who receive XOLAIR. This usually, but not always, happens in people who also take a steroid medicine by mouth that is being stopped or the dose is being lowered. It is not known whether this is caused by XOLAIR. Tell your healthcare provider right away if you have rash; chest pain; shortness of breath; or a feeling of pins and needles or numbness of your arms or legs.
  • Fever, muscle aches, and rash. Some people who take XOLAIR get these symptoms 1 to 5 days after receiving a XOLAIR injection. If you have any of these symptoms, tell your healthcare provider.
  • Parasitic infection. Some people who are at a high risk for parasite (worm) infections, get a parasite infection after receiving XOLAIR. Your healthcare provider can test your stool to check if you have a parasite infection.
  • Heart and circulation problems. Some people who receive XOLAIR have had chest pain, heart attack, blood clots in the lungs or legs, or temporary symptoms of weakness on one side of the body, slurred speech, or altered vision. It is not known whether this is caused by XOLAIR.

The most common side effects of XOLAIR:

  • In adults and children 12 years of age and older with asthma: pain especially in your arms and legs, dizziness, feeling tired, skin rash, bone fractures, and pain or discomfort of your ears.
  • In children 6 to less than 12 years of age with asthma: common cold symptoms, headache, fever, sore throat, pain or discomfort of your ear, abdominal pain, nausea, vomiting and nose bleeds.
  • In people with chronic idiopathic urticaria: nausea, headaches, swelling of the inside of your nose, throat or sinuses, cough, joint pain, and upper respiratory tract infection.

These are not all the possible side effects of XOLAIR. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555 or Novartis Pharmaceuticals Corporation at (888) 669-6682.

Please see full Prescribing Information, including Medication Guide, for additional Important Safety Information.

*Eligible patients pay $5 per drug co-pay until a maximum of $10,000 of co-pay assistance per 12-month period is reached.

XOLAIR® and its logo are registered trademarks of Novartis AG.

©2017 Genentech USA, Inc. and Novartis Pharmaceuticals Corporation. All rights reserved.

Questions about this program?
Call (855) XOLAIR-CARD (855-965-2472)
9 a.m.–8 p.m. ET, Monday through Friday, except major holidays

This Web site is a service of Genentech, Inc. and Novartis Pharmaceuticals Corporation and is intended for US residents only. XOL/041515/0084(3) XOL/042915/0106(3) XOL/042915/0107(3)