Does Medicare Cover Xolair (omalizumab)?
Xolair is a brand-name prescription medication known as a biologic. Its active ingredient is omalizumab. Generic versions of biologic drugs are called biosimilars. Due to complex manufacturing processes, biosimilar medications are similar to the original biologic version but not identical. Only the brand-name version of this medication is currently available.
Xolair (omalizumab) has a boxed warning for anaphylaxis. This is the most serious warning the Food and Drug Administration (FDA) can require of a medication.
Medicare Part B may cover the associated eligible expenses because a doctor or another healthcare professional in a doctor’s office gives this medication. Part D prescription drug plans may cover eligible costs if they eventually allow a person to administer the medication at home.
Part D plans may cover costs if a person needs take-home medications following Xolair (omalizumab). Private insurance companies administer Part D prescription drug plans on Medicare’s behalf, so drug costs and availability can vary by plan type and provider.
When medically necessary, a doctor or another healthcare professional may give a person a prescription for Xolair (omalizumab) if they have:
They may also prescribe Xolair (omalizumab) with other drugs for chronic sinusitis with nasal polyps.
Medicare Part B covers limited outpatient medications, including those administered in a doctor’s office, hospital outpatient department, or another medical facility. Coverage may usually be from Part B because doctors usually give Xolair (omalizumab) via subcutaneous injection.
Once a person pays their Part B plan deductible, which is $257 in 2025, they must pay a 20% coinsurance.
If a person’s healthcare team decides that it is safe for the person to administer the medication themself, Part D prescription drug plans may cover the costs.
Not all Part D prescription drug plans have a deductible, but if a person’s plan has one, they will join at this stage.
Once they pay the plan deductible in full, the plan can begin paying its share of eligible costs.
During this stage, people pay a 25% coinsurance toward the Xolair (omalizumab) costs.
In 2025, they can continue paying the 25% coinsurance until they pay $2,000. In 2026, this may increase to $2,100.
During this stage, a person may pay no further costs toward their prescription medications for the remaining calendar year.
They may receive an explanation of benefits (EOB) the month after their pharmacy bills their plan provider. The EOB may detail the:
Xolair is a brand-name medication containing the active ingredient omalizumab. The medication has FDA approval to treat hives called chronic spontaneous urticaria, specific asthma types, and some food allergies.
People must take Xolair as an injection under their skin. A doctor or another healthcare professional gives a person the first few doses. After a short time, and if the doctor deems it safe, the person may be able to self-inject the medication at home. In this instance, the Medicare part that covers costs may change, so it is important to be aware of this to manage cost expectations.
Xolair (omalizumab) is a biologic medication, meaning manufacturers make the drug with parts of living organisms. Some biologics weaken immune system activity, but Xolair (omalizumab) works differently.
The medication attaches to a bodily protein called immunoglobulin E (IgE), which the immune system makes. This protein recognizes foreign substances in a person’s body.
Different immune system cells in a person’s body have IgE receptors, and when IgE activates them, the receptors cause inflammation.
Xolair (omalizumab) prevents this activation and stops the inflammation responsible for asthma, specific food allergies, and nasal polyps. It also reduces IgE protein levels in the body, which can help relieve hives.
Xolair (omalizumab) affects a different part of a person’s immune system than other biologic medications, so it may increase their risk of infections, including serious infections like tuberculosis (TB).