OnabotulinumtoxinA (Botox)

OnabotulinumtoxinA (Botox) is covered for multiple FDA‑approved indications in adults (and blepharospasm/strabismus in those ≥12 years) and specified off‑label compendial uses (e.g., excessive salivation, achalasia, hemifacial spasm, anal fissure, spasmodic dysphonia, oromandibular dystonia) and is excluded for patients with hypersensitivity to botulinum toxins or active infection at the injection site; general coverage is for ages ≥12. Coverage requires indication‑specific diagnostic criteria and prior therapy trials (e.g., anticholinergic failure for bladder indications; ≥2 preventive agents failed for chronic migraine with ≥15 headache days/month lasting ≥4 hours), documentation of diagnosis, planned dose/interval per policy (typical 12‑week dosing; migraine initial authorization 6 months, others 12 months), and objective benefit on reauthorization (e.g., ≥50% reduction in migraine days or documented improvement in spasticity).

"Spasmodic dysphonia (laryngeal dystonia)"