Does Medicare Cover Xolair?

The drug Omalizumab, marketed under the brand name Xolair, is an immunotherapy used for the treatment of chronic spontaneous asthma and chronic idiopathic urticaria. It’s applied via a subcutaneous injection.

When Does Medicare Pay for Xolair?

Medicare Part D prescription drug plans and Medicare Advantage (Part C) plans with drug coverage may cover Xolair injections. Check your specific insurance plan to see if it’s covered.

If you're comparing plans before enrollment, be sure to compare the plan details such as the summary of benefits to find out how drugs are covered. You can search the plan's formulary (list of covered drugs) online or chat with a licensed insurance agent who can help you compare plans to find one that covers Xolair.

Xolair Side Effects

Some of the most common side effects of Xolair are rashes and severe muscle pain that appear up to 5 days after the injection is administered. Other reactions may occur depending on age and prescription intent.

• For adults or children over 12 who have asthma, the most common side effects are dizziness, lethargy, bone fractures, ear pain and pain in the arms or legs
  
  
• For children with asthma between the ages of 6 and 12, stomach, throat and ear infections are possible
  
  
• In the same age group, bleeding and swelling of the nose, stomachache, fever and headaches may occur
  
  
• In adults who suffer from nasal polyps, the most common reactions are dizziness, stomach pain, headache and joint pain
  
  
• For those treating chronic spontaneous urticaria, possible reactions are joint and head pain, nausea, swelling in the throat or nose and respiratory infections

Dizziness and drowsiness are other common side effects of the drug, so it’s important not to drive, operate heavy machinery or use dangerous objects until the effects wear off. All side effects should be monitored and reported to your doctor. 

Despite showing excellent results, Xolair is not indicated for just any case, and there are restrictions that cannot be ignored.

The drug should only be prescribed under the following conditions, according to the manufacturer:

• People 6 years of age and older who have moderate to severe and persistent asthma that cannot be controlled with inhaled corticosteroids
  
  
• People 18 years of age or older who have nasal polyps who cannot control symptoms with nasal corticosteroids
  
  
• People aged 12 years and older who suffer from chronic urticaria who cannot control their symptoms with an H1 antihistamine.

When It’s Time to See a Doctor

In addition to monitoring all side effects with your doctor — even the most common ones — it's critical to seek emergency care if you experience any of the following reactions:

• Anxiety
• Shortness of breath
• Chest or throat pain
• Difficulty breathing or swallowing
• Swelling in the throat or tongue
• Hives, rashes or itching
• Whistling in the ear
• Low blood pressure
• Hoarse voice
• Extreme dizziness and drowsiness

These reactions are related to a possible serious allergic reaction known as anaphylaxis. It can occur after the first dose or even in those who’ve been using the drug for long durations. Anaphylaxis can potentially lead to death, so it’s critical for those taking Xolair to be mindful of these side effects and seek immediate medical attention should they arise.

Cases of Cancer and Heart Problems

In rare cases, cases of cancer have been reported in those using Xolair, though more research is needed to determine whether any causal relationship exists.

The company that manufactures Xolair also reports that some people who have used the drug have reported chest pain, heart attack, clots in the lungs or legs, altered vision, weakness on one side of the body and slurred speech. However, there’s no confirmation that these situations were caused by using Xolair.

Xolair Interactions

Before taking Xolair injections, it’s important to inform your doctor of other allergies you have, as you could be allergic to certain components of the medication.

It’s also critical to share information with your doctor, such as whether you’ve had cancer in the past or have other respiratory problems, so your doctor can evaluate whether Xolair is right for you. 

Pregnant or breastfeeding women should also not take the medication without a doctor's authorization.

Interaction With Other Drugs

Before you start using Xolair, tell your doctor about all the medications you use on a daily basis, even non-prescription and natural supplements.

If you already use other medications to treat asthma, hives or nasal polyps, never stop or reduce your use of these medications without your doctor's permission.

Xolair Dosing

Xolair injections are available in two doses, 75mg or 150mg, given one at a time at 2- or 4-week intervals. Your prescribing doctor determines the dosage and application. It’s also important to note that the first injection should always be administered by a healthcare professional. 

Should you or a caregiver need to administer a Xolair injection, it’s necessary to undergo adequate training and have the authorization of a healthcare professional. 

Never try to inject the medicine yourself without proper training. In children aged 6 to 11, the administration should only be performed by a trained caregiver or healthcare professional.

Additional Information

If you’re prescribed Xolair, keep in mind that it can take a few months for the medication to take full effect. During this time, it’s crucial to continue taking Xolair as prescribed.

Don’t stop taking the medication without first consulting your doctor. Additionally, if you’re switching from a steroid to Xolair, don’t discontinue the use of your steroid abruptly.

How Does Xolair Affect Your Immune System?

Xolair functions by preventing IgE from binding to IgE receptors on basophils and mast cells. Basophils and mast cells are cells in your immune system that contain heparin and histamine.

When IgE binds to its receptor, it results in the release of heparin and histamine from mast cells. Xolair is approved by the FDA as a treatment for patients with moderate to severe asthma.