Advice regarding Xolair (omalizumab) Claiming

Page last updated: 8 August 2025

The department is aware of the issues with prescribing and claiming omalizumab PBS items since 1 August 2025.

For existing omalizumab prescriptions dated prior to 1 August 2025, approved suppliers can dispense either 150mg syringe Omlyclo [EW] or 150mg pen device Xolair [NV]. The patient does not need to obtain a new prescription for the 150mg pen device.

Some pharmacies are receiving PBS Online claim rejections R738 (the item provided was not a PBS benefit as at the date of prescribing) due to the incorrect bio grouping between the Private Hospital (14904K, 10110D) and Public Hospital (14949T, 10118M) omalizumab 75mg item codes. Services Australia have advised they will monitor and honour eligible PBS claims with the rejection R738 in a separate payment after the data is corrected in the 1 September 2025 schedule update.

There is a known issue where the Online PBS Authorities application (OPA) is not correctly assessing that the patient has an authority in their history for the ‘same drug’. If prescribers receive a rejection RC820 (previous treatment for the same indication with same drug required) via HPOS, please phone Services Australia who will override the rejection. Services Australia is implementing an urgent ICT fix for this and will advise in this channel when this has been resolved.