Botulinum Toxins A and B
Medical benefit coverage criteria and authorization rules for FDA-approved botulinum toxin type A and B products for UnitedHealthcare members; affects provider requests for initiation and continuation of botulinum toxin therapy. State-specific exceptions apply for several states listed.
Any FDA-approved and launched botulinum toxin product not listed by name in this policy will be considered non-preferred until reviewed by UnitedHealthcare.
Botox (onabotulinumtoxinA) and Xeomin (incobotulinumtoxinA) are the preferred botulinum toxin products; coverage is contingent on the Diagnosis-Specific Criteria section.
Coverage for Dysport, Daxxify, Myobloc, or other non-preferred botulinum toxin products will be provided contingent on Preferred Product section criteria and Diagnosis-Specific Criteria.
Members already receiving non-preferred products will be required to change therapy to Botox or Xeomin to continue coverage unless they meet Preferred Product section exceptions.
Treatment with Dysport, Daxxify, Myobloc, or other non-preferred products is medically necessary when either (a) prior trial of Botox or Xeomin had minimal response and physician attests superior response expected with non-preferred agent, or (b) physician attests intolerance/contraindication or serious adverse event would not be expected with the non-preferred product.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.