AbobotulinumtoxinA (Dysport)
EVICORE-MEDICAL_DRUG-3AA93427
Dysport (abobotulinumtoxinA) is covered for FDA‑approved uses (adult cervical dystonia, adult upper‑limb spasticity, pediatric lower‑limb spasticity ≥2 years) and specified compendial off‑label uses (blepharospasm, hemifacial spasm, adult achalasia). Coverage requires documentation of the covered diagnosis and age, no injection‑site infection, no hypersensitivity to botulinum toxins or cow’s‑milk protein, achalasia patients must have failed pneumatic dilatation or be non‑surgical candidates, potency units are non‑interchangeable, and authorization is limited to 12 months.
"Cervical dystonia in adults"
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