Does Medicare Cover Xolair? 

For many seniors, allergies are a mild annoyance that, at worst, require an over-the-counter (OTC) allergy medication to keep symptoms at bay. For others, however, allergies can lead to breathing difficulties and a worsening of asthma. Others cause severe skin reactions that cause hives. Seniors in the latter group are sometimes diagnosed with chronic spontaneous urticaria (CSU), an allergic condition in which the development of hives has no known cause.

What causes severe allergic reactions related to asthma?

Allergic reactions that trigger asthma in seniors are often caused by allergens in the air. Pollen is a common trigger, but dust and mold may also cause allergies that lead to a worsening of asthma. In severe cases, an asthma attack can narrow the airways and make it difficult to breathe. When this happens, asthma can be life-threatening.

What causes hives to develop?

In terms of allergic reactions on the skin, exposure to certain foods, medications and physical stimuli can trigger the development of hives. As noted above, a condition like chronic spontaneous urticaria may mean that the development of hives resulting from an allergic reaction has no known cause. CSU used to be referred to as chronic idiopathic urticaria (CIU) with “idiopathic” meaning the origin of the condition has no known cause.

How are severe allergic reactions treated?

Seniors who experience asthma or hives resulting from allergic reactions may require the use of medications and lifestyle changes. Rescue inhalers may help some seniors who suffer from asthma, but these are not always sufficient to ward off symptoms. In terms of skin reactions to allergens, OTC medications and topical treatments may help. In cases where these remedies are not enough, your doctor may prescribe medications like Xolair.

What is Xolair?

Xolair (omalizumab) is a prescription medication that is injected. Each syringe contains a pre-measured dose of the medication, and seniors who are prescribed Xolair can have the medication administered in a doctor’s office or can administer the medication on their own at home or while traveling. Xolair has not been indicated to treat certain allergic conditions in children and should only be used by adults as prescribed.

Xolair works by releasing histamines that have bound themselves to mast cells via IgE receptors. These receptors are the pathways used to trigger an immune response. Histamines are the primary cause of allergic reactions which is why OTC antihistamine drugs are often effective at combating routine allergy symptoms.

Does Medicare cover Xolair?

Medicare benefits cover Xolair when the medication has been prescribed by a doctor to treat a medical condition. Medicare coverage for prescription drugs is usually supplied through Medicare Part D, but in the case of Xolair, Medicare coverage may be supplied by Part B as well.

Medicare Part B is outpatient insurance that covers things like doctor visits and clinical care. Because Xolair is often administered in a clinical setting, the injection may be considered outpatient care. If a Xolair prescription is available for purchase from a retail pharmacy, Medicare Part D provides coverage instead.

How much does Xolair cost?

Medicare costs can vary by plan and coverage allowances. In the case of Medicare Part D, your costs may include a monthly premium, a deductible that must be met prior to benefits applying toward your medications and a copay that is due at the time you purchase your medications. To learn more about copay costs and medication availability, consult your Part D plan’s formulary.

If Xolair is covered by Medicare benefits through Part B, Medicare recipients pay a monthly premium, must meet a separate deductible and will pay a coinsurance of 20% for each outpatient service.