Medicare AdvantagePrior AuthMedium impact
MA08.025i, Omalizumab (Xolair®) and related biosimilars
Independence Blue Cross·Allergy & Immunology, Pulmonology, Dermatology·Pharmacy
Effective date
Mar 23, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the policy for Omalizumab (Xolair®) and related biosimilars with changes to medical necessity criteria, medical coding requirements, and general guidelines. This is a fresh policy update that affects pharmacy-related billing for this asthma and chronic hives medication.
Action Required
Before March 23, 2026: Billing team must review updated medical necessity criteria for Omalizumab (Xolair®) and biosimilars in Medicare Advantage plans. Update prior authorization workflows and documentation requirements based on new criteria. Verify current coding guidelines align with updated policy requirements.