Medicare Advantage Drug Cost for Xolair Pfs



There are 44 Medicare Advantage Plans with additional prescription drug coverage for Xolair Pfs available to residents in Massachusetts. The average retail unit cost (e.g. per pill) for a 30-day supply at in-area retail pharmacies is $1,233.38 ($37,001.30). Xolair Pfs is typically listed as a Tier 5 drug on the formulary and does not require prior authorization.

Below is the average retail cost and your co-pay for Xolair Pfs in Massachusetts. You can also see if each plan requires prior authorization, step therapy or has drug quantity limits. Please check the formulary for different brand and generic drug names. Every Medicare Advantage Plan will vary in coverage, co-pays, costs and premiums. This chart can help you sort through different plan details to find a Medicare Advantage Plan in Bristol with the best coverage and the cheapest prices for your medications in Massachusetts.



Proprietary Name:Xolair Pfs
Generic Name:Omalizumab
Drug Package:1 Syringe, Glass In 1 Carton > 1 Ml In 1 Syringe, Glass
Drug Strength:150mg/mL
Substance:Omalizumab
Dosage Form:Injection, Solution
Route:Subcutaneous
Labeler:Genentech, Inc.
Pen Name:Human Prescription Drug
NDC#50242021501
RX#2058946
Days Supply:30
Coverage Phase:Initial Coverage
Plan Year:2023
County:Bristol





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Medicare Advantage Coverage for Xolair Pfs in Massachusetts


Click the Plan Name for More Details
Click the header to sort
Plan
Name ⇅
Tier
Level
Your
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/
Days
Prior
Auth
Y/N
Step
Therapy
Y/N
Avg
Unit
Cost
(x30)
AARP Medicare Advantage Choice

5NA33%33%/YN$1,278.62
($38,358.56)
AARP Medicare Advantage Choice

5NA28%28%/YN$1,278.62
($38,358.56)
AARP Medicare Advantage Plan 1

5NA30%30%/YN$1,278.62
($38,358.56)
AARP Medicare Advantage Plan 2

5NA30%30%/YN$1,278.62
($38,358.56)
Aetna Medicare Explorer Plan

533%33%33%/YN$1,292.99
($38,789.55)
Aetna Medicare Value Plan

530%30%30%/YN$1,292.99
($38,789.55)
CCA Medicare Preferred

5NA29%NA/YN$1,376.76
($41,302.84)
CCA Medicare Value

5NA25%NA/YN$1,376.76
($41,302.84)
Fallon Medicare Plus Blue HMO

5NA33%NA/YN$1,171.67
($35,150.19)
Fallon Medicare Plus Green HMO

5NA29%NA/YN$1,171.67
($35,150.19)
HumanaChoice H5216-138

5NA28%28%/YN$1,281.01
($38,430.44)
HumanaChoice H5216-249

5NA28%28%/YN$1,281.01
($38,430.44)
HumanaChoice H5216-250

5NA29%29%/YN$1,281.01
($38,430.44)
Medicare HMO Blue FlexRx

528%28%28%/YN$1,179.70
($35,390.99)
Medicare HMO Blue PlusRx

529%29%29%/YN$1,229.03
($36,870.90)
Medicare HMO Blue SaverRx

528%28%28%/YN$1,229.03
($36,870.90)
Medicare HMO Blue ValueRx

527%27%27%/YN$1,179.70
($35,390.99)
Medicare PPO Blue PlusRx

529%29%29%/YN$1,229.03
($36,870.90)
Medicare PPO Blue SaverRx

530%30%30%/YN$1,229.03
($36,870.90)
Medicare PPO Blue ValueRx

528%28%28%/YN$1,256.65
($37,699.50)
Senior Whole Health Medicare Choice Care

5NA31%NA/YN$1,172.51
($35,175.27)
Tufts Medicare Preferred HMO Basic Rx

529%29%NA/YN$1,213.25
($36,397.53)
Tufts Medicare Preferred HMO Prime Rx

5NA33%NA/YN$1,175.08
($35,252.33)
Tufts Medicare Preferred HMO Prime Rx Plus

5NA33%NA/YN$1,175.08
($35,252.33)
Tufts Medicare Preferred HMO Saver Rx

529%29%NA/YN$1,211.37
($36,341.06)
Tufts Medicare Preferred HMO Smart Saver Rx

531%31%NA/YN$1,211.37
($36,341.06)
Tufts Medicare Preferred HMO Value Rx

533%33%NA/YN$1,213.25
($36,397.53)
Wellcare Giveback Open

527%27%27%/YN$1,274.29
($38,228.81)
Wellcare No Premium

533%33%33%/YN$1,274.29
($38,228.81)
Wellcare No Premium Open

533%33%33%/YN$1,274.29
($38,228.81)
Wellcare Premium Enhanced Open

533%33%33%/YN$1,274.29
($38,228.81)


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SNP Prescription Drug Cost for Xolair Pfs

Click the Plan Name for More Details about that Plan
Click the header to sort
Plan
Name ⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Amt
Mail
Limit
Days/
Amt
Prior
Auth
Y/N
Step
Therapy
Y/N
Avg
Unit
Cost
(x30)
Align Connect

5NA25%NA/YN$1,243.61
($37,308.30)
Align Thrive

5NA25%NA/YN$1,243.61
($37,308.30)
CCA Senior Care Options

5NA25%NA/YN$1,376.76
($41,302.84)
NaviCare

1NA$0NA/YN$1,171.24
($35,137.35)
Senior Whole Health

1NA$0NA/YN$1,165.26
($34,957.71)
Senior Whole Health NHC

1NA$0NA/YN$1,165.26
($34,957.71)
Tufts Health Plan Senior Care Options

1NA$0NA/YN$1,175.29
($35,258.78)
UnitedHealthcare Senior Care Options

5NA$0NA/YN$1,278.62
($38,358.56)
UnitedHealthcare Senior Care Options NHC

5NA$0NA/YN$1,278.62
($38,358.56)
WellSense Senior Care Options

1NA$0NA/YN$1,137.99
($34,139.77)


Do any Medicare Advantage Plans Cover Xolair Pfs? Yes, 44 Medicare Advantage Plans cover this drug in Massachusetts.

How much does Xolair Pfs Cost? $1,233.38, the average retail cost in Massachusetts is $1,233.38 per unit or $37,001.30 for a 30-day supply at in-area pharmacies.

What Tier is Xolair Pfs? Tier 5, most Advantage Plans list Xolair Pfs on Tier 5 on their formulary. Usually, the higher the tier, the more you have to pay for the medication.

Do I need Prior Authorization for Xolair Pfs? Yes, the majority of Medicare Prescription Plans do require prior authorization from your doctor for Xolair Pfs.



Additional Notes by Medicare Help:

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1.Pre-Deductable: Before you reach the plans deductible. Some plans offer select Pre-deductible drug Coverage
2.Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit.
3.Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7550 in 2022.
4.Catastrophic: Anything over $7550 you will receive a significant increase in coverage.

Formulary Definitions:

Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Cost Preferred: Your Cost for the Drug at the Providers In Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization in order to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Avg Unit Cost: Average unit cost (e.g. per pill) for specified days supply at in-area retail pharmacies. A pharmacy is considered in-area when it is geographically located in the service area.




What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plans formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Last updated on
Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

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