Medicare AdvantageCoverageMedium impact
MA08.025h, Omalizumab (Xolair®)
Independence Blue Cross·Allergy & Immunology, Pulmonology, Pharmacy·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.025h updates Medicare Advantage coverage guidelines for Omalizumab (Xolair®), a monoclonal antibody used for moderate-to-severe allergic asthma and chronic idiopathic urticaria. The policy became effective October 1, 2025. Billing teams must review this recent policy to ensure claims comply with updated prior authorization, medical necessity, and coverage criteria for this pharmaceutical.
Action Required
By October 1, 2025: Billing team must obtain and review the full text of policy MA08.025h from the source URL to identify specific prior authorization requirements, covered indications, dosing limits, and any documentation requirements for Omalizumab (Xolair®). Update billing system rules and prior authorization workflows to align with the new guidelines. Providers should be notified of any changes to medical necessity documentation requirements. Failure to comply with updated coverage criteria will result in claim denials. Access the complete policy at: https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=10&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#medicare-advantage-ma08-025h-omalizumab-xolair