Effective January 4, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will require use of the self-administered formulation of Xolair billed under the pharmacy benefit for all members who can use a self-injectable or have a caregiver that is able to administer.

If the member/caregiver can self-administer but the provider would like to continue to administer the medication in the healthcare setting for other reasons, the medication would need to be obtained from an in-network specialty pharmacy provider. The member would then need to take the medication to the provider’s office, or the specialty pharmacy can have the medication shipped directly to their office. The provider will be able to bill for the administration of the drug but not for the drug itself.

The prior authorization criteria for coverage under the pharmacy benefit can be found on the prior review plan page by searching and selecting Xolair- Pharmacy criteria. A list of in network pharmacies can be found on the Pharmacy page. Please verify all member's specific benefits and in network specialty pharmacies.

For additional information, please review the medical criteria policy for Xolair.