Xolair® (Omalizumab) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers provider‑administered Xolair (omalizumab) for FDA‑aligned indications — moderate‑to‑severe persistent allergic asthma (age ≥6 with perennial allergen sensitivity and baseline total IgE 30–1300 IU/mL), chronic idiopathic urticaria (age ≥12 refractory to H1 antihistamines), chronic rhinosinusitis with nasal polyps (adults ≥18 with inadequate response to intranasal steroids), and IgE‑mediated food allergy (age ≥1) — and excludes acute bronchospasm/status asthmaticus and other unproven indications (e.g., seasonal/perennial allergic rhinitis, atopic dermatitis, emergency anaphylaxis treatment); concomitant use of other biologics for the same indication is prohibited. Coverage requires documented diagnosis and confirmatory testing, specified prior therapy trials, indication‑specific prescriber specialty, FDA‑label dosing, provider administration under the medical benefit (plan exceptions apply), baseline/follow‑up objective measures, and authorization up to 12 months with reauthorization contingent on demonstrated clinical benefit.