omalizumab-igec

150 MG/ML, 300 MG/2ML, 75MG/0.5ML — Prefilled Syringe

Also known as: OMLYCLO

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 10 hours, 15 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via Omlyclo	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Omlyclo	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Omlyclo	Not Covered	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 10 hours, 15 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via Omlyclo	Tier 3 - Non-Formulary	✓	—	—	PA PA: TPA - SELECT DRUGS REQUIRES PRIOR AUTHORIZATION (NEW TO MARKET DRUGS)