CommercialPrior AuthMedium impact
State and School Employees' Health Insurance Plan - Xolair (omalizumab)
Blue Cross & Blue Shield of Mississippi·Allergy & Immunology, Pulmonology, Dermatology +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
New comprehensive prior authorization policy for Xolair (omalizumab) for State and School Employees' Health Insurance Plan, covering four conditions: chronic spontaneous urticaria, moderate-to-severe persistent asthma, chronic rhinosinusitis with nasal polyps, and food allergies. Detailed eligibility criteria, dosing requirements, and renewal conditions are specified with 6-month approval periods.
Action Required
Immediately: Billing team must implement prior authorization requirements for all Xolair (omalizumab) claims for State and School Employees' Health Insurance Plan members. Verify patient meets specific eligibility criteria including age requirements, IgE levels, weight parameters, and prior therapy failures before administration. Ensure prescriber is appropriate specialist or has specialist consultation. Submit initial authorizations for 6-month approval periods and track renewal requirements. Claims will be denied without proper prior authorization.