OnabotulinumtoxinA (Botox)

Covers onabotulinumtoxinA (Botox) for FDA‑approved and select off‑label compendial indications (e.g., overactive bladder, neurogenic detrusor overactivity, chronic migraine prophylaxis, adult/pediatric limb spasticity, cervical dystonia, hyperhidrosis, blepharospasm/strabismus, excessive salivation, achalasia, anal fissure, hemifacial spasm, spasmodic dysphonia, oromandibular dystonia) and excludes use that does not meet indication‑specific preconditions (e.g., active UTI/urinary retention, non‑neurogenic incontinence, non‑refractory hyperhidrosis, or lack of required prior therapies). Key requirements include documentation of the specific diagnosis and required prior therapy/trial failures or diagnostic criteria (for example anticholinergic failure for OAB/detrusor overactivity, ≥15 headache days/month and failure of ≥2 preventive agents for chronic migraine with reauthorization only after ≥50% reduction in headache days), adherence to per‑indication dosing, per‑site and frequency limits (usually ≤12‑week intervals and specified unit maxima or weight‑based pediatric dosing), and specified initial (migraine 6 months, others 12 months) and reauthorization (12 months) durations.