Provider Briefing: The Xolair Supply Landscape in 2026
The supply challenges surrounding Xolair (Omalizumab) have been a persistent clinical and operational headache for allergists, pulmonologists, immunologists, and other prescribers since late 2023. As we move through 2026, the situation has improved but remains unresolved — and staying current on the supply picture is essential for patient management and practice planning.
This briefing covers the timeline of the shortage, current availability, prescribing implications, the biosimilar landscape, cost and access considerations, and tools to help your patients maintain access to treatment.
Timeline: How We Got Here
Understanding the shortage requires context on the sequence of events:
- June 2003: FDA approves Xolair for moderate to severe allergic asthma.
- March 2014: FDA expands approval to chronic spontaneous urticaria (CSU).
- December 2020: FDA approves Xolair for chronic rhinosinusitis with nasal polyps (CRSwNP) in adults.
- February 2024: FDA approves Xolair for IgE-mediated food allergy — the first approved medication for this indication. This approval dramatically expanded the eligible patient population.
- Late 2023 – 2024: Supply constraints emerge and worsen as demand surges. Specialty pharmacy backorders become common.
- 2025: FDA approves Omlyclo (Omalizumab-igec), a biosimilar by Mylan/Viatris. Manufacturing capacity gradually increases.
- 2026: Supply is improved but intermittent constraints persist, particularly for certain dose strengths and in some geographic regions.
Prescribing Implications
The supply situation creates several practical challenges for prescribers:
Treatment Initiation Delays
New patients starting Xolair may face longer waits for their first dose. This is particularly concerning for food allergy patients where the goal is to provide a safety net against accidental exposure. Consider confirming pharmacy stock before writing the prescription.
Dose Interruption Risks
For established patients, missed doses can lead to clinical consequences:
- Asthma: Loss of asthma control, increased exacerbation risk, potential need for oral corticosteroid rescue
- CSU: Return of urticaria symptoms, often within 4-8 weeks of discontinuation
- CRSwNP: Polyp regrowth and symptom recurrence
- Food allergy: Loss of the protective effect against accidental allergen exposure
Biosimilar Considerations
The availability of Omlyclo (Omalizumab-igec) provides a clinically equivalent alternative. Key points for prescribers:
- Omlyclo is FDA-approved as a biosimilar to Xolair with no clinically meaningful differences in safety or efficacy.
- Interchangeability designation allows pharmacy-level substitution in states that have adopted interchangeable biosimilar laws.
- Some patients may have concerns about switching — proactive communication about biosimilar equivalence can help.
- Formulary placement varies by insurer. Check with the patient's plan before assuming coverage.
Alternative Biologic Selection
When Xolair is unavailable and the clinical situation demands treatment, alternative biologics may be appropriate:
- For asthma: Dupixent (Dupilumab), Nucala (Mepolizumab), Fasenra (Benralizumab), or Tezspire (Tezepelumab) — selection should be guided by phenotype and biomarkers.
- For CRSwNP: Dupixent is the primary alternative.
- For CSU: No other approved biologic; consider higher-dose antihistamines or off-label Cyclosporine.
- For food allergy: No direct alternative biologic. Oral immunotherapy (e.g., Palforzia for peanut allergy) or strict avoidance with emergency epinephrine remain the fallback.
For patient-facing information on alternatives, direct them to Alternatives to Xolair.
Current Availability Picture
Availability in 2026 is best characterized as variable:
- Prefilled syringes and autoinjectors (75 mg and 150 mg) are generally more available than the lyophilized powder vial.
- Higher-dose patients (requiring multiple vials per dose) may face more difficulty, as their orders consume more supply per patient.
- Geographic variation exists — urban centers with multiple specialty pharmacy options tend to have better access than rural areas.
- The biosimilar is increasingly stocked but not yet universally available at all specialty pharmacies.
Real-time availability data can be accessed through Medfinder for Providers, which allows clinicians to check stock at nearby pharmacies before prescribing.
Cost and Access Landscape
Cost remains a significant barrier for many patients:
- Cash price: $1,500 to $4,000+ per injection depending on dose
- Annual cost: $30,000 to $50,000+ without assistance
- Prior authorization: Required by virtually all commercial and Medicare plans
- Step therapy: Many plans require documented failure of inhaled corticosteroids (asthma), antihistamines (CSU), or nasal corticosteroids (CRSwNP) before approving Xolair
Patient Assistance Resources
- Genentech Co-pay Program: Reduces commercial copays to as low as $0 per dose for eligible patients
- Genentech Patient Foundation: Provides free Xolair for uninsured/underinsured patients meeting income criteria
- Support for You Program: Nurse support, injection training, financial navigation
- NeedyMeds / RxAssist: Third-party databases of patient assistance programs
For a comprehensive patient-facing resource on saving money, refer patients to How to Save Money on Xolair in 2026.
Tools and Resources for Your Practice
- Medfinder for Providers: Real-time pharmacy stock checking. Helps you verify availability before sending a prescription to a specific pharmacy.
- Genentech's HCP Portal: Dosing calculators, prior authorization support, and sample request tools.
- Specialty pharmacy partnerships: If your practice administers Xolair in-office via buy-and-bill, establishing relationships with multiple distributors can help ensure continuity of supply.
Looking Ahead
The medium-term outlook for Xolair supply is cautiously optimistic:
- Biosimilar competition should continue to improve both supply and pricing.
- Manufacturing expansion by Genentech is underway, though biologic capacity additions take time to come online.
- Additional biosimilars may enter the market, further alleviating supply constraints.
- Self-injection adoption is reducing the burden on in-office administration supply chains.
However, demand is unlikely to decrease. The food allergy patient population is still growing into the Xolair treatment pathway, and new data supporting its use in additional allergic conditions may further expand utilization.
Final Thoughts
The Xolair shortage has tested the resilience of allergy and immunology practices nationwide. As prescribers, the most impactful things you can do are: verify stock before prescribing, stay informed on the biosimilar landscape, maintain relationships with multiple specialty pharmacy partners, and proactively communicate with patients about supply timelines and alternatives.
Tools like Medfinder for Providers can streamline the process of matching prescriptions with available supply. For a hands-on guide to helping patients navigate the shortage, see How to Help Your Patients Find Xolair in Stock.
Additional resources for your patients:
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