Omalizumab (Xolair)

Aetna covers omalizumab (Xolair) for allergic moderate-to-severe asthma in patients ≥6 years (requires positive perennial aeroallergen test, pre-treatment total serum IgE ≥30 IU/mL, inadequate control despite optimized medium‑to‑high‑dose ICS plus another controller and evidence of recent exacerbations or poor control; prior biologic use for asthma may also be a covered pathway), for chronic spontaneous urticaria in patients ≥12 years who remain symptomatic despite up‑dosed second‑generation H1 antihistamines and evaluation for other causes, and for CRSwNP in adults ≥18 who either previously received a biologic for CRSwNP or meet objective polyp/symptom criteria despite intranasal corticosteroids. Precertification and site-of-care rules apply, baseline IgE is required for asthma dosing (repeat IgE monitoring not needed for dose changes), patients must continue maintenance therapies while on Xolair, and Xolair is not indicated for acute bronchospasm/status asthmaticus or other non‑labeled allergic conditions.