CommercialPrior AuthMedium impact
08.00.55n, Omalizumab (Xolair®) and related biosimilars
Independence Blue Cross·Allergy & Immunology, Pulmonology, Dermatology·Pharmacy
Effective date
Mar 23, 2026
We identified it
Jun 19, 2026
Summary
Insurance policy 08.00.55n for Omalizumab (Xolair®) and related biosimilars has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects pharmacy billing for this asthma and chronic urticaria medication.
Action Required
Before March 23, 2026: Billing team must review updated medical necessity criteria for Omalizumab (Xolair®) and biosimilar claims. Update prior authorization workflows and documentation requirements per new policy guidelines. Providers should ensure proper coding and medical necessity documentation to prevent claim denials.