![]() ![]() You can continue to use your pharmacy card or submit requests for reimbursements during your designated grant cycle. Call your healthcare provider or get emergency help right away if you get any of the following symptoms of an allergic reaction: rash breathing problems hives red, itchy. Xolair is used to treat moderate to severe asthma that is caused by allergies in adults and children who are at least 6 years old. XOLAIR ® (omalizumab) for subcutaneous use is an injectable prescription medicine used to treat: moderate to severe persistent asthma in people 6 years of age and older whose asthma symptoms are not well controlled with asthma medicines called inhaled corticosteroids. The Drug Co-pay Program shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. Territories and are void where prohibited by law. The Programs are only valid in the United States and U.S. Xolair (omalizumab) is an antibody that helps decrease allergic responses in the body. The patient or their guardian must be 18 years of age or older to receive assistance from the Programs. This website is a service of Genentech, Inc. If you currently have a grant with HealthWell, your grant will remain active for the entire 12 month grant cycle or until you have exhausted your allocated grant amount, whichever comes first. Amgen and AstraZeneca can reduce or eliminate co-pay program benefits at any time, including if your plan does not apply benefits to satisfy your out-of-pocket costs. Xolair Copay assistance, and patient assistance programs are available for eligible patients. ET, Monday through Friday (except major holidays) For questions about XOLAIR, please call (866) 4XOLAIR (86). Please continue to visit our Disease Funds page often, as replenished funds reopen as quickly as possible. I also certify that, to the best of my knowledge, the information on this reimbursement request form is true and correct. While we continue to manage the existing grants in our Closed Funds, they are temporarily closed to new patients due to lack of sufficient funding. ![]() Our Re-enrollment Funds are open only to patients who have had and used a grant with HealthWell in the past. Our Open Funds are now accepting grant applications. ![]()
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