Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list J2357, and 44 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
J6 · Effective Apr 1, 2026
44 policies from 20 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab (Xolair)Effective 01/01/2019 - 07/31/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Omalizumab (Xolair)Effective 05/01/2022 - 04/30/2023 | May 1, 2022 | Prior auth requiredInferred from policy title |
| Omalizumab (Xolair)Effective 05/01/2023 - 03/31/2024 | May 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Omalizumab (Xolair)Effective 06/01/2021 - 04/30/2022 | Jun 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Omalizumab (Xolair)Effective 07/01/2020 - 05/31/2021 | Jul 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Omalizumab (Xolair)Effective 08/01/2019 - 06/30/2020 | Aug 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Xolair (omalizumab) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Xolair (omalizumab)Effective 04/01/2024 - 06/30/2024 | Apr 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Xolair (omalizumab)Effective 04/01/2025 - 04/30/2026 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Xolair (omalizumab)Effective 07/01/2024 - 03/31/2025 | Jul 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Policy | Effective | Status of J2357 |
|---|---|---|
| Xolair (omalizumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xolair (omalizumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xolair (omalizumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xolair (omalizumab) Pre-filled Syringe and Autoinjector | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xolair (omalizumab) Pre-filled Syringe for Self-administration | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Xolair (Omalizumab) | Oct 1, 2025 | Covered |
| Xolair (Omalizumab) – Community Plan Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xolair (Omalizumab) – Individual Exchange Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab (Xolair) and related biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Omalizumab (Xolair) and related biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J2357 |
|---|---|---|
| State and School Employees' Health Insurance Plan - Xolair (omalizumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Xolair (omalizumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab (Xolair) and related biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Omalizumab (Xolair) and related biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Xolair (Omalizumab) | Oct 1, 2025 | Covered |
| Policy | Effective | Status of J2357 |
|---|---|---|
| OMALIZUMAB/XOLAIR | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab Xolair | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab Products: Omalizumab (Xolair); Omalizumab-igec (Omlyclo) | Apr 14, 2004 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab (Xolair) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab (Xolair),Omalizumab-igec (Omlyclo); CP.PCH.49 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Omalizumab (Xolair) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| 00222 omalizumab (Xolair) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Xolair (omalizumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J2357 |
|---|---|---|
| Xolair (Omalizumab) | Oct 1, 2025 | Covered |