Summary
The Xolair (omalizumab) policy update effective 10/01/2025 revised the initial and renewal criteria for chronic spontaneous urticaria, moderate-to-severe persistent asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), and added a dosing table for adult CRSwNP. A 09/04/2026 review changed 'endoscopy' to 'nasal endoscopy' in the CRSwNP criteria and added otolaryngologist to the list of qualifying specialists. Prior authorization is required, and the use of samples is not considered current or stable therapy.
Get alerts when payers change rules like this one
We check Blue Cross & Blue Shield of Mississippi and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross & Blue Shield of Mississippi alertsPolicy Monitoring is free. No card required.
What to do
Action · 7 steps
01Already effective 2025-10-01: Get prior authorization for Xolair (omalizumab) and check the current applicability of this policy version before billing.
02The initial approval length is 6 months and the renewal approval length is 12 months.
03For CRSwNP, the prescriber must be a specialist in the area of the diagnosis or have consulted with one, and otolaryngologist is listed as a qualifying specialist.
04If the request is for Xolair vials to be administered by a healthcare professional, the individual must have tried unsuccessfully to use self-administered Xolair or be clinically unable to do so.
05Medical records from the provider that list previously prescribed medications are not sufficient to show medication trials or adherence.
06The prescribed dosage must be within the program quantity limit based on FDA approved labeled dosage.
07Services related to delivery or administration of a medication not approved through the BCBSMS PA review process will be considered not medically necessary.
Codes mentioned
J2357J44.0J44.1J45.21J45.22J45.31J45.32J45.41J45.42J45.51J45.52J45.901J45.902L50.1
Original notice
Xolair (omalizumab)
bcbsms.com · Always check the source before changing claims.
Related changes
See all Blue Cross & Blue Shield of Mississippi changes →Home Non-Invasive Positive Airway Pressure Devices for the Treatment of Respiratory Insufficiency and FailureMediumNo effective date · Medical PolicyState and School Employees' Health Insurance Plan - Xolair (omalizumab)MediumNo effective date · Medical PolicyHeart/Lung TransplantMediumNo effective date · Medical PolicyProvider-Administered Drugs Coding PolicyHighNo effective date · CodingBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list