Varies by plan

Does Alignment Healthcare require prior authorization for Xolair?

Prior authorization for Xolair differs across Alignment Healthcare's Medicare Part D plans and product strengths — 3 of 7 Xolair products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.

By product strength

RxNorm product	Plans covering	Require prior auth	Status
omalizumab 150 MG Injection [Xolair]1657212	67 / 67	67	Prior authorization required
1 ML omalizumab 150 MG/ML Prefilled Syringe [Xolair]2058946	67 / 67	67	Prior authorization required
0.5 ML omalizumab 150 MG/ML Prefilled Syringe [Xolair]2058950	67 / 67	67	Prior authorization required
2 ML omalizumab 150 MG/ML Prefilled Syringe [Xolair]2663918	0 / 67	0	Not on formulary
2 ML omalizumab 150 MG/ML Auto-Injector [Xolair]2663923	0 / 67	0	Not on formulary
1 ML omalizumab 150 MG/ML Auto-Injector [Xolair]2673761	0 / 67	0	Not on formulary
0.5 ML omalizumab 150 MG/ML Auto-Injector [Xolair]2673763	0 / 67	0	Not on formulary

Product names come from RxNorm (U.S. National Library of Medicine).

Plan-by-plan detail — omalizumab 150 MG Injection [Xolair]

Xolair has 7 products in the corpus; this table is for omalizumab 150 MG Injection [Xolair], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Alignment Health + Intermountain Health (HMO)	H9686-009	5	Yes	No	No
Alignment Health Advantage PPO (PPO)	H8832-001	5	Yes	No	No
Alignment Health Advantage PPO (PPO)	H8832-002	5	Yes	No	No
Alignment Health AllCare Preferred (HMO)	H3815-011	5	Yes	No	No
Alignment Health AVA (PPO)	H7074-001	5	Yes	No	No
Alignment Health Balance (HMO C-SNP)	H3815-033	5	Yes	No	No
Alignment Health Balance (PPO)	H4961-006	5	Yes	No	No
Alignment Health BreathEasy (HMO C-SNP)	H3815-041	5	Yes	No	No
Alignment Health Clarity (HMO C-SNP)	H3815-042	5	Yes	No	No
Alignment Health CommUnity (HMO)	H3815-046	5	Yes	No	No
Alignment Health Dual Select+ (HMO-POS D-SNP)	H5472-007	5	Yes	No	No
Alignment Health Freedom (PPO)	H8832-003	5	Yes	No	No
Alignment Health Harmony (HMO)	H3815-031	5	Yes	No	No
Alignment Health Heart & Diabetes (HMO C-SNP)	H3443-003	5	Yes	No	No
Alignment Health Heart & Diabetes (HMO C-SNP)	H3815-010	5	Yes	No	No
Alignment Health Heart & Diabetes (HMO C-SNP)	H9686-004	5	Yes	No	No
Alignment Health Heart & Diabetes (HMO-POS C-SNP)	H5472-002	5	Yes	No	No
Alignment Health Heart & Diabetes Access (HMO C-SNP)	H3815-044	5	Yes	No	No
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP)	H3443-007	5	Yes	No	No
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP)	H3815-039	5	Yes	No	No
Alignment Health Heart & Diabetes Care (HMO C-SNP)	H3815-048	5	Yes	No	No
Alignment Health Heart & Diabetes Care (HMO C-SNP)	H3815-054	5	Yes	No	No
Alignment Health Heart & Diabetes Care (HMO C-SNP)	H5296-011	5	Yes	No	No
Alignment Health Heart & Diabetes Choice (HMO C-SNP)	H3815-051	5	Yes	No	No
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	H5296-009	5	Yes	No	No
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP)	H9686-006	5	Yes	No	No
Alignment Health Heart & Diabetes Plus (HMO C-SNP)	H3443-006	5	Yes	No	No
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP)	H5472-004	5	Yes	No	No
Alignment Health Honor+ Plan (HMO)	H3815-052	5	Yes	No	No
Alignment Health L.A. Premium Giveback (HMO)	H3815-055	5	Yes	No	No
Alignment Health My Choice (HMO)	H3815-001	5	Yes	No	No
Alignment Health My Choice (HMO)	H3815-028	5	Yes	No	No
Alignment Health My Choice (PPO)	H4961-001	5	Yes	No	No
Alignment Health My Choice (PPO)	H4961-003	5	Yes	No	No
Alignment Health My Choice CalCare (HMO)	H3815-050	5	Yes	No	No
Alignment Health My Choice Select (HMO)	H3815-049	5	Yes	No	No
Alignment Health NC Duals (HMO-POS D-SNP)	H5296-004	5	Yes	No	No
Alignment Health Platinum (HMO)	H5296-003	5	Yes	No	No
Alignment Health Platinum + Instacart (HMO-POS)	H3815-016	5	Yes	No	No
Alignment Health Platinum + Instacart (HMO)	H3815-008	5	Yes	No	No
Alignment Health Platinum + Instacart (HMO)	H5296-007	5	Yes	No	No
Alignment Health Platinum + Instacart (HMO)	H9686-007	5	Yes	No	No
Alignment Health Platinum Select (HMO)	H5296-010	5	Yes	No	No
Alignment Health S.D. Premium Giveback (HMO)	H3815-056	5	Yes	No	No
Alignment Health Silicon (HMO C-SNP)	H3815-045	5	Yes	No	No
Alignment Health smartHMO (HMO-POS)	H5472-003	5	Yes	No	No
Alignment Health smartHMO (HMO)	H3443-005	5	Yes	No	No
Alignment Health smartHMO (HMO)	H3815-013	5	Yes	No	No
Alignment Health smartHMO (HMO)	H3815-038	5	Yes	No	No
Alignment Health smartHMO (HMO)	H3815-040	5	Yes	No	No
Alignment Health smartHMO (HMO)	H5296-006	5	Yes	No	No
Alignment Health smartHMO (HMO)	H5296-008	5	Yes	No	No
Alignment Health smartHMO (HMO)	H9686-008	5	Yes	No	No
Alignment Health smartSavings (HMO-POS)	H5472-010	5	Yes	No	No
Alignment Health smartSavings (HMO)	H3815-047	5	Yes	No	No
Alignment Health Sutter Advantage +More (HMO)	H3815-019	5	Yes	No	No
Alignment Health Sutter Advantage +More (HMO)	H3815-020	5	Yes	No	No
Alignment Health Sutter Advantage +More (HMO)	H3815-021	5	Yes	No	No
Alignment Health Sutter Advantage +More (HMO)	H3815-023	5	Yes	No	No
Alignment Health the ONE (HMO D-SNP)	H9686-005	5	Yes	No	No
Alignment Health the ONE (HMO)	H3815-034	5	Yes	No	No
Alignment Health the ONE + Walgreens (HMO-POS)	H5472-001	5	Yes	No	No
Alignment Health the ONE + Walgreens (HMO)	H3443-001	5	Yes	No	No
Alignment Health the ONE + Walgreens (HMO)	H3443-002	5	Yes	No	No
Alignment Health the ONE + Walgreens (HMO)	H3815-035	5	Yes	No	No
Alignment Health Total Dual+ (HMO-POS D-SNP)	H5472-009	5	Yes	No	No
Alignment Health ValorCare (HMO)	H3815-053	5	Yes	No	No

Source

Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File

Effective: 2026-06-30
Retrieved: 2026-07-19
SHA-256: e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae

We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.

Xolair at other payers

Or see Xolair across every payer at once.

Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.