Summary
UnitedHealthcare Community Plan of Nebraska revised its omalizumab medical benefit drug policy, retitling it from Xolair to omalizumab and naming Omlyclo (omalizumab-igec) and Xolair as covered products, with any FDA-approved and launched biosimilar not named treated as non-preferred until UnitedHealthcare reviews it. HCPCS code Q5154 was added to the applicable codes, and the revision takes effect 2026-12-01. Billing teams should update charge entry and product references for omalizumab claims for Nebraska Medicaid members, and confirm which omalizumab product is being administered before submitting.
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What to do
Action · 3 steps
01By 2026-12-01: Billing team should add HCPCS Q5154 to the charge master and update omalizumab charge entry in the practice management system for Nebraska Medicaid members, so claims reflect the product actually administered (Omlyclo, Xolair, or a named biosimilar).
02Providers and front desk staff should be told that omalizumab for in-office administration is under the medical benefit, while self-administered omalizumab is obtained under the pharmacy benefit.
03Any FDA-approved omalizumab biosimilar not listed by name in the policy is considered non-preferred until reviewed by UnitedHealthcare, so flag those cases in the prior authorization tracker before scheduling.
Codes mentioned
Q5154
Original notice
Omalizumab
uhcprovider.com · Always check the source before changing claims.
Related changes
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