Medicare AdvantageAdministrativeMedium impact
MA08.025i, Omalizumab (Xolair®) and related biosimilars
Independence Blue Cross·Allergy & Immunology, Pulmonology, Pharmacy·Pharmacy
Effective date
Mar 23, 2026
We identified it
Jun 19, 2026
Summary
Policy MA08.025i updates medical necessity criteria, medical coding requirements, and general guidelines for Omalizumab (Xolair®) and related biosimilars effective March 23, 2026. The billing team must review updated coverage criteria and coding rules to ensure compliant claim submission for this biologic asthma/allergic condition medication.
Action Required
By March 23, 2026: Billing team must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=03&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#medicare-advantage-ma08-025i-omalizumab-xolair-and-related-b to identify specific billing codes, medical necessity documentation requirements, and any prior authorization changes. Update billing system rules, encounter forms, and provider guidelines accordingly. Ensure all Xolair claims processed after the effective date comply with the new medical necessity criteria to prevent denials.