Botulinum Toxins

Abstract

Botulinum Toxin Type A Based on review of available data, the Company may consider the use of botulinum toxin Type A products (Botox, Dysport, or Xeomin) to be eligible for coverage** for any of the following conditions: • Strabismus ∞ • Blepharospasm or facial nerve (VII) disorders (including hemifacial spasm) ∞ • Cervical dystonia (spasmodic torticollis; applicable whether congenital, due to child birth injury, or traumatic injury). For this use, cervical dystonia must be associated with sustained head tilt or abnormal posturing with limited range of motion in the neck AND a history of recurrent involuntary contraction of one or more of the muscles of the neck, e.g., sternocleidomastoid, splenius, trapezius, or posterior cervical muscles ∞ • Upper limb spasticity ∞ • Lower limb spasticity ∞ • Axillary hyperhidrosis that is inadequately managed with topical agents ∞ • Urinary incontinence due to detrusor overactivity associated with a neurologic condition (e.g., Spinal Cord Injury, Multiple Sclerosis) in patients who have an inadequate response to or are intolerant of an anticholinergic medication ∞ • Overactive bladder (OAB) in adults unresponsive to or intolerant of an anticholinergic medication ∞ • Chronic migraine headaches ∞: