Medicare AdvantagePrior AuthMedium 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
The medical necessity criteria for Omalizumab (Xolair®) under Medicare Advantage plans has been updated effective January 6, 2025. This may change prior authorization requirements or documentation standards for this asthma and chronic urticaria medication.
Action Required
Immediately: Review updated medical necessity criteria for Omalizumab (Xolair®) prescriptions for Medicare Advantage patients. Verify current prior authorization requirements and update documentation templates to ensure compliance with new criteria. Contact the payer to confirm specific requirements if prescribing this medication.