Omalizumab (Xolair)

Covers Xolair for FDA‑approved indications—moderate‑to‑severe persistent asthma (age ≥6) with positive allergy testing and baseline IgE ≥30 IU/mL, chronic idiopathic urticaria (age ≥12) refractory to high‑dose H1 antihistamines—and compendial off‑label use for allergic rhinitis (age ≥12) with positive testing; other off‑label uses are not covered. Coverage requires allergist/immunologist/pulmonologist prescribing or consultation, specified baseline IgE and positive skin/in‑vitro testing where required, documented prior therapy trials (asthma: ≥3 months ICS + additional controller; urticaria: >6 weeks symptoms despite H1 antihistamines up‑titrated to 4× dose; rhinitis: concurrent trials from two drug groups and immunotherapy status), dosing limits (asthma max 375 mg q2w; urticaria max 300 mg q4w), initial approvals ~4 months and reauthorization after ≥4 months with documented clinical benefit.

"The treatment of moderate to severe persistent asthma in individuals with a positive skin test or in vitro reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with ..."