RimabotulinumtoxinB (Myobloc®)

Myobloc (rimabotulinumtoxinB) is covered only for adults (≥18) with FDA‑approved cervical dystonia (≤5,000 units per treatment) or chronic sialorrhea (≤3,500 units per treatment), administered no more frequently than every 12 weeks with approvals effective for 12 months. Coverage requires documentation of the diagnosis and patient age and clinical records supporting the planned dosing/distribution, and use for non‑FDA indications is excluded.

"Treatment of adults with cervical dystonia."

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