NEW START XOLAIR:
-What insurance does the patient have? Medicare- in office through Healix required, Commercial- can do in office through Healix or self-admin at home (make sure we have copies of insurance cards)
-Does the patient prefer in office or are they comfortable with self-administering the med? In office- Healix buy&bill, Self-administration- Specialty pharmacy benefits
-ALL new start xolairs: Complete/ submit xolair application and PAN form, review our office policies and black box warning/ anaphylaxis
HEALIX:
-Message KK1 or KK2 for location code
-Add pt to that Healix “location”: enter pt demographics, insurance info, route office visit notes to Britt to upload
-complete Healix order form and sent to Britt to upload
-Check on pt's “Log” periodically to make sure Healix has everything needed for PA
SPP (self-admin at home): *MAKE SURE PT IS COMFORTABLE SELF-ADMINISTERING*
-create phone note and route to KK2 for PA through pharmacy benefits
XOLAIR
1. CIU (L50.1 or L50.8) - insurances don't like L50.9 -documentation of at least trial and failure of up-dosed H1 and H2 histamine blockers *Some insurances asking for affected BSA %
2. Moderate-to-severe asthma (J50.40, J50.50) -history of positive skin or RAST test to perennial aeroallergen -raised total IgE -documentation of symptoms being inadequately controlled with ICS
3. Nasal polyps (J33.9, J33.0, J33.8) -documentation of inadequate response to nasal corticosteroids
4. IgE mediated food allergy (Z91.010, Z91.011, Z91.012, Z91.013) -Clinical history consistent with IgE-mediated food allergy -Positive IgE and/or positive skin prick test and/or Oral Food Challenge to allergenic food(s) -Pretreatment serum IgE level IU/mL