Botox (onabotulinumtoxinA)

Botox is covered for the listed FDA‑approved and certain off‑label compendial indications (e.g., overactive bladder/detrusor overactivity including neurogenic cases, chronic migraine prophylaxis, upper/lower limb and pediatric spasticity ≥2 years, cervical dystonia, primary axillary hyperhidrosis, blepharospasm, strabismus, and others) but is excluded in the presence of active UTI or urinary retention except for patients routinely performing clean intermittent catheterization and subject to other indication‑specific contraindications. Key requirements include documented prior therapy failures (e.g., anticholinergics for OAB, ≥2 preventive agents for chronic migraine, topical therapy for hyperhidrosis, failed conservative measures for anal fissure, or poor response to pneumatic dilatation for achalasia), age/weight‑based dosing and maximum frequency limits (generally not more often than every 12 weeks), specified authorization durations (initial migraine 6 months, others 12 months), and documentation of therapeutic benefit for reauthorization (e.g., ≥50% reduction in migraine days).