Asthma is a breathing condition that affects people of all ages, but if you are vulnerable due to illness or a chronic condition, asthma can be especially troubling. Many Medicare recipients over the age of 65 and under 65 who qualify due to certain disabilities experience asthma and visit a physician for treatment. The most common treatment for asthma is an inhaler that delivers corticosteroids directly into the lungs. These devices are typically used on an as-needed basis. Unfortunately, not everyone responds to inhaler treatment, and because asthma can be both environmental and allergic, advanced medication may be necessary to keep symptoms at bay.
Aside from difficulty breathing, allergic reactions can also lead to the development of chronic hives, or chronic idiopathic urticaria. These are hives without a known cause, meaning there may not be a direct allergic cause that can be treated directly, but the body is still reacting as if histamines are present. Allergic reactions in the body are usually treated with anti-histamine medications, but as with allergic asthma, not everyone responds to traditional treatment. If other treatments are ineffective, more complex medications like Xolair may be prescribed.
What is Xolair?
Xolair (omalizumab) is an injectable medication used in the treatment of allergic asthma and chronic hives with no known cause. Generally, it is prescribed to patients who have not found success using traditional asthma inhalers or antihistamine medications. Unlike many prescriptions, Xolair can be used to treat children ages six and older, and Xolair may be used as part of a holistic treatment plan in conjunction with other medications. A blood test is required for asthma patients who are considered eligible for Xolair to determine dosage, but patients suffering from hives do not require a blood test.
If you’re prescribed Xolair, it’s important to monitor yourself for side effects as they may present themselves after many doses. This means that even if you don’t experience side effects after the first use, side effects may develop in the future where none were present previously. Side effects may include trouble breathing and wheezing, anxiety and low blood pressure and itching and feeling warm. While some side effects are mild and simply cause discomfort, others, like swelling of the throat, can be life-threatening, so you will need to work closely with your physician to monitor your progress while on Xolair.
Does Medicare Cover Xolair?
There are many Medicare recipients who receive Xolair to treat their asthma symptoms. In the majority of cases, Xolair is covered by Medicare Part B because Xolair is injected at a physician’s office. Part B (Medical Insurance) helps cover the costs of outpatient care, services, and supplies. It is optional, but many individuals choose to enroll in Part B when they are first eligible to avoid late enrollment penalties. You will likely pay a premium for Part B, and be responsible for a yearly deductible.
Medicare Part D helps cover prescription drugs as listed in each plan’s formulary, but because Xolair is not available at a retail pharmacy and is not considered a self-administered medication, Part D would likely offer no coverage for the medication. On the other hand, if Xolair is administered during a hospital admittance or while being cared for in a skilled nursing facility, Medicare Part A would be billed first. Patients who have a Medicare Advantage plan would also receive the same Part A and Part B coverage, but these MA enrollees may also have additional coverage.