Omlyclo

Generic: omalizumab-igec

75 MG, 150 MG — Prefilled Syringe

1.25GM, 1.5GM, 1.75GM, 2GM, 5GM, 10GM,

Also known as: OMLYCLO SOSY 75MG/0.5ML, 150MG/ML, Omlyclo Sosy

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 2 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - HDHP 2026 Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jul 31, 2026  ·  Checked: 2 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via omalizumab-igec
Tier 3 - Non-Formulary — — — None
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