Medical Policy Updates

Notification of Policy Revisions Effective January 4, 2022 (Posted November 4, 2021)

Medical Policy Revision
Omalizumab (Xolair®) "Notification" Added requirement for use of the self-administered product unless certain criteria are met. For nasal polyposis indication: added requirement of step through Xhance, removed requirement for nasal saline irrigations, and added requirement for previous surgery for nasal polyps. Policy notification given 11/4/2021 for effective date 1/4/2022.