Summary
Effective 2026-12-01, UnitedHealthcare Community Plan of Indiana (Medicaid) revised its omalizumab medical benefit drug policy, retitling it from Xolair to omalizumab and covering Omlyclo (omalizumab-igec), Xolair, and any FDA-approved, launched omalizumab biosimilar. Biosimilars not named in the policy are considered non-preferred until UnitedHealthcare reviews them, and HCPCS code Q5154 was added. Self-administered omalizumab is obtained under the pharmacy benefit rather than the medical benefit.
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What to do
Action · 2 steps
01By 2026-12-01: Billing team should update charge entry and the payer's drug code crosswalk for Indiana Community Plan omalizumab claims so that Omlyclo (omalizumab-igec), Xolair, and HCPCS Q5154 are recognized, and should flag any other omalizumab biosimilar billed to this plan as non-preferred pending UnitedHealthcare review.
02Providers and front desk staff should be told that self-administered omalizumab for these members is routed to the pharmacy benefit, so medical-benefit scheduling and billing should be confirmed for each order before the service date.
Codes mentioned
Q5154
Original notice
Omalizumab
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →OmalizumabMediumEffective Dec 1, 2026 · Medical Benefit Drug PolicyOmalizumabMediumEffective Dec 1, 2026 · Medical PolicyOmalizumabMediumEffective Dec 1, 2026 · Medical Benefit Drug PolicyOmalizumabMediumEffective Dec 1, 2026 · Medical Benefit Drug PolicyBrowse every UnitedHealthcare change in the policy list