Xolair (omalizumab subcutaneous injection - Genentech/Novartis) — Cigna

Initial criteria

• Patient is ≥ 6 years of age
• Patient has a baseline immunoglobulin E (IgE) level ≥ 30 IU/mL
• Baseline is defined as prior to receiving any treatment with Xolair or another monoclonal antibody therapy that may lower IgE levels (e.g., Dupixent [dupilumab subcutaneous injection], Tezspire [tezepelumab-ekko subcutaneous injection])

Approval duration

4 months