OnabotulinumtoxinA (Botox)

Covered for listed FDA indications (OAB/neurogenic detrusor overactivity, chronic migraine prophylaxis, adult spasticity, cervical dystonia, severe axillary hyperhidrosis, blepharospasm/strabismus ≥12 y) and specified compendial off‑label uses (e.g., excessive salivation, achalasia, hemifacial spasm); excluded for patients with hypersensitivity to botulinum toxins, infection at the injection site, urinary tract infection/urinary retention for intradetrusor use, or age <12. Key requirements include documentation of diagnosis and safety (age ≥12, no hypersensitivity/infection/UTI), condition‑specific prior therapy failures (e.g., inadequate response/intolerance to anticholinergics for OAB/neurogenic detrusor, ≥2 preventive agents for chronic migraine, failed pneumatic dilatation or not surgical candidate for achalasia), appropriate post‑void residual monitoring when indicated, and 12‑month authorization with standard toxin‑safety precautions.

"Overactive Bladder: Had an inadequate response or intolerance to an anticholinergic medication"