Medicare AdvantageCoverageMedium impact
MA08.025g, Omalizumab (Xolair®)
Independence Blue Cross·Allergy & Immunology, Pulmonology, Dermatology·Pharmacy
Effective date
Jan 6, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated the medical necessity criteria for Omalizumab (Xolair®), a specialty medication used primarily for asthma and chronic hives. The billing team should review the new criteria to ensure proper documentation and prior authorization requirements are met for claims involving this medication.
Action Required
By January 13, 2025: Billing team and providers must access the full policy at the source URL to review updated medical necessity criteria for Omalizumab (Xolair®). Update prior authorization checklists and ensure documentation meets new requirements before submitting claims. Coordinate with pharmacy team on HCPCS billing requirements for this specialty medication.