Omalizumab (Xolair®)

Covered only for FDA‑approved indications (allergic asthma ≥6 years, chronic spontaneous/idiopathic urticaria ≥12 years, nasal polyps ≥18 years) at indication‑specific dosing limits and excludes off‑label use. Approval requires specialist prescribing/consultation, baseline IgE ≥30 IU/mL (asthma and nasal polyps) and positive allergen test for asthma, specified prior therapy trials (≥3 months of required controller therapy for asthma; non‑sedating H1 antihistamines titrated to 4× dose for urticaria; ≥3 months intranasal corticosteroid plus prior systemic steroid/contraindication/prior surgery for nasal polyps), documented clinical response for reauthorization (≥4 months therapy for asthma/urticaria, ≥6 months for nasal polyps), initial authorization durations (4 months; 6 months for nasal polyps) and 12‑month renewals.

"Xolair is indicated for patients 6 years of age and older with moderate to severe persistent asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen and whose sympto..."