SOUTH SHORE CHARGE 10002800 OMALIZUMAB 150 MG SC SOLR Insurance and Self Pay Discounts 250 J2357 50242-040-62 $318.88

Omalizumab 150 mg Subcutaneous Injection (CPT J2357): Cost Overview

Omalizumab (brand name Xolair) is a monoclonal antibody administered as a 150 mg subcutaneous injection, commonly used to treat moderate to severe allergic asthma and chronic idiopathic urticaria. The listed fee of $318.88 generally includes the medication cost and administration. Actual out-of-pocket expenses vary widely based on insurance coverage, network status, and discounts for self-pay patients. Patients are encouraged to request itemized quotes from their provider and verify insurance coverage before treatment to understand potential costs and avoid unexpected charges.

Cost Breakdown

• Standard Fee: $318.88 per 150 mg dose
• Self-Pay Discounted Rate: $167.21
• Insurance Payment Range: $81.02 – $271.05 (varies by plan)
• Examples by Plan:
  • Aetna W: $111.92
  • Anthem Blue Preferred: $86.77
  • Cigna PPO: $268.55
  • Humana HMO: $81.87
  • UHC Individual Exchange: $81.02

Associated Costs & Considerations

• Additional Doses: Some patients require multiple injections per visit (cost multiplies accordingly).
• Administration Fee: Sometimes billed separately; verify with your clinic.
• Monitoring: Initial injections may require observation for allergic reactions, potentially adding facility fees.
• Follow-up Visits: Office visit charges may apply in addition to the drug cost.

Insurance & Payment Advice

• Contact your insurance to confirm coverage, network status, and copay/coinsurance amounts for CPT J2357.
• Ask if you qualify for patient assistance programs or manufacturer copay cards, especially if uninsured or underinsured.
• Request an itemized estimate from your provider, including the drug, administration, and facility fees.
• Check if pre-authorization is required to avoid claim denials.

Side-Effect & Recovery Considerations

• Mild side effects may include injection site reactions, headache, or fatigue.
• Rare but serious allergic reactions (anaphylaxis) can occur; monitoring after the first few doses is recommended.
• Most patients can resume normal activities immediately after the injection.

Frequently Asked Questions

• What is Omalizumab used for?
  Omalizumab is prescribed for allergic asthma not controlled by inhaled steroids and for chronic idiopathic urticaria (hives) that doesn’t respond to antihistamines.
• How much does a single injection cost without insurance?
  The standard self-pay rate per 150 mg injection is approximately $167.21, but this can vary by provider and region.
• Why do costs differ between insurance plans?
  Each insurance plan negotiates different rates with providers and may cover different portions of the medication and administration fees.
• Does the listed fee include administration and monitoring?
  The fee usually covers the medication itself; administration and monitoring may be billed separately depending on your provider’s billing practices.
• Will I need prior authorization for Omalizumab?
  Most insurance plans require prior authorization for specialty medications like Omalizumab. Check with your insurer before starting treatment.
• Can I use a manufacturer copay card or patient assistance program?
  Yes, many patients qualify for copay assistance or patient support programs, especially if insurance coverage is limited or out-of-pocket costs are high.
• Are there cost differences for higher or more frequent dosing?
  Yes, patients needing multiple injections per visit or more frequent dosing will incur higher total costs, as charges are generally per 150 mg dose.
• What should I do if I can’t afford my medication?
  Ask your provider about patient assistance programs, payment plans, or switching to a facility that offers better self-pay discounts.
• What side effects should I watch for after the injection?
  Common side effects include redness or swelling at the injection site. Rarely, severe allergic reactions can occur; seek immediate help if you experience difficulty breathing or swelling of the face/lips.
• Can I get Omalizumab injections at home?
  Some patients may be eligible for at-home administration after initial doses in a clinical setting, but this depends on insurance coverage and your healthcare provider’s assessment.
• Is the cost per injection or per treatment course?
  The quoted price is per 150 mg injection; the total cost per treatment course depends on the number and frequency of injections prescribed.

Aurora SOUTH SHORE
CHARGE
10002800
OMALIZUMAB 150 MG SC SOLR
Rev 250
CPT J2357
NDC 50242-040-62

Fee $318.88

Self-Pay $167.21

Insurance

Minimum $159.44
Maximum $271.05
Aetna W $111.92
Aetna PPO $264.80
Anthem Blue Priority $86.77
Anthem Blue Preferred $86.77
Anthem PPO $271.05
Aurora Caregiver $77.16
Centivo $86.31
Cigna GPPO $189.55
Cigna PPO $268.55
Common Ground ETF Network $87.22
Common Ground Exchange Envision $87.22
Common Ground Group Envision $87.22
Everpointe Elite $83.03
Health EOS Plus $194.51
Health EOS PPO $255.11
HealthPartners ETF $83.20
HealthPartners Robin Focused $103.43
HealthPartners Broad $239.16
HPS $97.49
HST $157.95
Humana HPN $81.87
Humana HMO $81.87
Humana PPO $268.65
Molina Exchange $119.15
Quartz One $147.49
Quartz Group $173.68
Trilogy $172.60
UHC Individual Exchange $81.02
UHC Charter $81.02
UHC Nexus $81.02
UHC HMO $85.09
UHC PPO $268.68
WPS Aurora Featured Network $158.85
WPS Arise $167.21
WPS Statewide $167.21