AbobotulinumtoxinA (Dysport®)

Policy covers Dysport for FDA‑approved uses (cervical dystonia; upper and lower limb spasticity in patients ≥2 years) and specified compendial off‑label uses (blepharospasm, hemifacial spasm, anal fissure, chronic sialorrhea) and excludes indications not listed. Approvals are for up to 12 months with indication‑specific maximum doses and limits (e.g., cervical dystonia and adult upper limb ≤1,000 units; adult lower limb ≤1,500 units; pediatric upper limb 16 U/kg ≤640 U; pediatric lower limb 15 U/kg unilateral or 30 U/kg bilateral or ≤1,000 U), injections no more frequently than the stated intervals (commonly every 12 weeks; some indications every 3 months or every 16 weeks), and a 1 mL maximum volume per injection site for adult limb spasticity.

"Cervical dystonia"

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