UnitedHealthcare
Botox (onabotulinumtoxinA)
Drugs for Nerves and Muscles : Drugs for Nerves and Muscles
  • Step Therapy: Migraine Prevention:
    ST Multiple Generics

  • Prior Authorization: Blepharospasm, Cervical Dystonia, Chronic Sialorrhea, Spasticity: Adult, Spasticity: Lower Limb:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Migraine Prevention:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)

  • Blepharospasm, Cervical Dystonia:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

    Chronic Sialorrhea, Spasticity: Adult, Spasticity: Lower Limb:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Migraine Prevention:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes

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