CommercialCoverageMedium impact
08.00.55l, Omalizumab (Xolair®)
Independence Blue Cross·Allergy & Immunology, Pulmonology, Pharmacy·Pharmacy
Effective date
Jan 6, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.00.55l regarding Omalizumab (Xolair®) has been updated effective January 6, 2025. This is a coverage and/or reimbursement position change for this pharmacy benefit. The billing team must review the full policy text to identify specific coverage criteria, prior authorization requirements, and reimbursement changes that may affect claims processing.
Action Required
By January 6, 2025: Billing and prior authorization teams must access the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=01&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-00-55l to extract detailed coverage criteria, prior auth requirements, and reimbursement rates for Omalizumab (Xolair®). Update billing system rules, PA workflows, and clinical criteria templates accordingly. Communicate changes to providers and pharmacy staff. Failure to implement changes may result in claim denials or improper reimbursement for Xolair® claims submitted on or after the effective date.