Xolair (omalizumab) — United Healthcare

Initial criteria

• EITHER (a) Patient established on Xolair with positive clinical response (reduction in exacerbations, itch severity, hives) AND not used with anti-IL4, anti-IL5, or TSLP inhibitor
• OR (b) Diagnosis of chronic urticaria AND remains symptomatic despite ≥2-week trial or intolerance to two H1-antihistamines (e.g., Allegra, Benadryl, Claritin) OR remains symptomatic despite ≥2-week trial or intolerance to one second-generation H1-antihistamine (e.g., fexofenadine, loratadine, cetirizine) plus another (different H1, H2 antihistamine, first-generation H1, or leukotriene modifier) AND not used with anti-IL4, anti-IL5, or TSLP inhibitor AND prescribed by allergist, dermatologist, or immunologist

Reauthorization criteria

• Positive clinical response (reduction in exacerbations, itch severity, hives) AND not used with anti-IL4, anti-IL5, or TSLP inhibitor

Approval duration

12 months