Xolair Patient Support Program Canada. Xolair® is currently funded under the Exceptional Access

Xolair® is currently funded under the Exceptional Access Program (EAP) for the treatment of asthma in patients 12 and older and chronic idiopathic urticaria (CIU). We can help you understand your health insurance coverage and find 2 CONTRAINDICATIONS Xolair (omalizumab) should not be administered to patients with known hypersensitivity to omalizumab or any component of the formulation (see 6 DOSAGE FORMS, Dosing is determined based on a patient’s IgE level and body weight, except in patients with CSU where dosing levels are prefixed. We are writing to you as you are a participant in the Xolair® Patient Support Program (Xhale+), a program offering support in relation Sign up to receive patient support resources, including information on getting started with XOLAIR. Please use this form to submit your application for Xolair to Canada Life. The Support For You Program is a network of resources that can help answer your Adult and pediatric patients (6 years of age and above) with moderate to severe persistent asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen and whose Innomar Strategies is Canada’s leading service provider for Patient Support Programs. *Clinical Education Managers and Contract Nurses are representatives of Learn about the financial assistance options for people taking XOLAIR® (omalizumab), including for those who don't have insurance. Xolair 75 mg pre-filled syringe and Xolair 150 mg pre Learn about the financial assistance options for people taking XOLAIR® (omalizumab), including for those who don't have insurance. Your healthcare professional should watch you for some time for signs . Your patients taking XOLAIR may not know what to expect from a biologic treatment. Keep this leaflet. Yes No If “Yes”, please provide the following information: Patient Support Program ID number: Patient Support Program contact name: Phone number: PART 4 – Coordination of benefits - A XOLAIR prescription is required for patients with food allergies. The program covers up to $1,500 per calendar The Genentech Patient Foundation provides free XOLAIR to people who don’t have insurance coverage or who have financial concerns and meet eligibility criteria. The Support For You Program can help address your patients’ treatment questions Your patients taking XOLAIR may not know what to expect Prescribing doctor's information: first/last name, practice name, address and phone Patient's financial eligibility information: number of people in the household (including patient) and With the XOLAIR co-pay program, eligible patients with commercial insurance may pay as little as $0 per XOLAIR injection out-of-pocket cost. 1. With the XOLAIR Co-pay Program, eligible patients with commercial insurance may pay as little as $0 per XOLAIR injection out-of-pocket cost. The program covers up to Anaphylaxis from Xolair can happen as early as after the first injection or hours later, and/or after any Xolair injection. See full prescribing, safety, & Boxed Warning info. You may need to read it again. See full safety for more information. We operate the most comprehensive national network of full XOLAIR Access Solutions can help identify the most appropriate patient assistance option to help your patient get the XOLAIR® (omalizumab) for subcutaneous use they have been prescribed. I have the patient’s consent to share with the Program the patient’s XOLAIR Co-pay Program With the XOLAIR Co-pay Program, eligible patients with commercial insurance may pay as little as $0 XOLAIR drug out-of-pocket cost. Eligible commercially insured patients who are prescribed XOLAIR for XOLAIR Access Solutions is a program that helps patients taking XOLAIR® (omalizumab) for subcutaneous use. I authorize Canada Life, any healthcare provider, my plan administrator, any insurance or reinsurance company, administrators of government benefits or patient support programs or Learn about XOLAIR Access Solutions, a resource that provides helpful access and reimbursement support to assist your patients and practice after XOLAIR® (omalizumab) for The final amount owed by patients may be as little as $0, but may vary depending on the patient's health insurance plan. The program Get answers to your questions about XOLAIR® (omalizumab) treatment by contacting us by email, phone, or mail. Please Nous communiquons avec vous en raison de votre participation au programme de soutien aux patients Xolair® (Xhale+), un programme offrant un soutien dans le cadre de Talk to your healthcare professional about your medical condition and treatment and ask if there is any new information about Xolair. 2. The Xolair 300 mg pre-filled syringe and all dose strengths of Xolair pre-filled pens are not intended for use in children under 12 years of age. Complete parts 2 to 7 in full and have your attending physician or nurse practitioner complete parts 8 to 9. If you have I consent to the patient being enrolled in the CELLTRION CONNECTTM Patient Support Program (the “Program”).

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