UnitedHealthcare
Xeomin (incobotulinumtoxinA)
Drugs for Nerves and Muscles : Drugs for Nerves and Muscles
  • 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)

    Pediatric Upper Limb Spasticity, Spasticity: Upper Limb:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

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

    Pediatric Upper Limb Spasticity, Spasticity: Upper Limb:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

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