Botox® (onabotulinumtoxinA) for Medicare Advantage

Covers onabotulinumtoxinA (Botox®) for the policy’s listed FDA‑approved indications (e.g., blepharospasm, cervical dystonia, chronic migraine prophylaxis, bladder/urodynamic conditions, upper/lower limb spasticity, strabismus) and numerous compendial off‑label uses (e.g., achalasia, chronic anal fissure, essential tremor, focal dystonias, hyperhidrosis variants, sialorrhea); indications not listed are not covered. Coverage requires indication‑specific criteria including minimum ages (ranging from 2 years upward as applicable), required prior therapy trials for many conditions (e.g., OAB/NDO, hyperhidrosis, migraine, essential tremor), documentation of diagnosis/age/weight/prior treatments/doses/clinical response, adherence to per‑indication dose maxima and re‑treatment intervals (generally no more frequently than every 12 weeks), and approvals are issued for 12 months.

"Blepharospasm"