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Cigna xolair prior authorization form 2026

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The document is a CIGNA HealthCare Prior Authorization Form for the medication Xolair (omalizumab). It outlines the necessary provider and patient information required for processing, including details about the patient's diagnosis, treatment history, and medication specifics. The form emphasizes the importance of completing all sections to avoid delays in processing and provides contact information for submitting the form and checking coverage positions.

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Click ‘Get Form’ to open the Cigna Xolair Prior Authorization Form in our platform.
Begin by filling out the 'Provider Information' section. Enter your name, specialty, DEA or TIN, office contact person, and contact details.
Next, complete the 'Patient Information' section. Provide the patient's name, CIGNA ID, date of birth, and address. Ensure all asterisked (*) fields are filled to avoid processing delays.
In the 'Medication Requested' section, specify Xolair (omalizumab), including dose and quantity. Indicate where the medication will be obtained from.
Fill out the 'Clinical Data' section by selecting the patient’s diagnosis and answering questions regarding their asthma condition and treatment history.
Review all entered information for accuracy before submitting. Once completed, use our editor's features to save or send the form directly via fax.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does Xolair require prior authorization?

If criteria for coverage are met, the initial authorization will be given for 12 weeks to assess the need for continued therapy. Requests for continuation of therapy will not be granted for patients who have not shown adequate response to omalizumab (Xolair) therapy.

Do most insurances cover XOLAIR?

For patients with commercial insurance, about 55% of patients paid $0 out-of-pocket costs per month for XOLAIR. For those patients who did have out-of-pocket costs, 90% paid between $5 to $1,475 per month, after satisfying their deductible. The amount you pay for XOLAIR will depend on your insurance plan.

How do I get a prior authorization form from Cigna?

Moving forward, please visit CoverMyMeds at .covermymeds.com/main/prior-authorization-forms/cigna/ or via SureScripts in your EHR to learn more and submit all new PA requests electronically. If you are unable to use electronic prior authorization, please call us at 1.800. 882.4462 (1.800. 88.

Who is not a candidate for XOLAIR?

It is not known if XOLAIR is safe and effective in people with CSU under 12 years of age. XOLAIR should not be used for the emergency treatment of any allergic reactions, including anaphylaxis. XOLAIR should also not be used to treat other forms of hives, or sudden breathing problems.

How much does XOLAIR cost without insurance?

The list price for Xolair without insurance is $5,000 for adults and about $3,000 for children per month. Most people will not pay the list price. The actual cost will vary based on your insurance coverage. Check your health insurance plan to see if youre covered for Xolair.

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How long do prior authorizations take with Cigna?

Heres how it typically works: Consult Your Doctor. Start by discussing your treatment plan and any specific medications your provider recommends. Contact Your Insurance Provider. Call your insurance company or log into their online portal to check if prior authorization is required. Submit the Request. Await Approval.

What are three drugs that require prior authorization?

Drugs That May Require Prior Authorization Drug ClassDrugs in Class Epidiolex Epidiolex Erythroid Stimulants , , Procrit and Retacrit, Mircera Esbriet Esbriet Evenity Evenity243 more rows

Cigna xolair prior authorization form 2026

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Got questions?

Does Xolair require prior authorization?

Do most insurances cover XOLAIR?

How do I get a prior authorization form from Cigna?

Who is not a candidate for XOLAIR?

How much does XOLAIR cost without insurance?

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