AbobotulinumtoxinA (Dysport®)

Covered: Dysport is authorized for cervical dystonia; upper and lower limb spasticity in patients ≥2 years; and compendial off‑label uses—blepharospasm, hemifacial spasm, anal fissure, and chronic sialorrhea; uses not on this list are not described as covered. Key requirements: 12‑month approvals require documentation of diagnosis and meeting specific criteria, adherence to indication‑specific maximum doses and injection volumes (e.g., adult upper limb ≤1,000 U, adult lower limb ≤1,500 U, 1 mL per limb injection site), pediatric dose caps (upper limb 16 U/kg to 640 U; lower limb 15 U/kg unilateral or 30 U/kg bilateral to ≤1,000 U), and minimum intervals (generally not more frequently than every 12 weeks, with some indications at 3 or 16 weeks).

"Cervical dystonia (FDA-approved indication)"

Sign up to see full coverage criteria, indications, and limitations.