Botulinum Toxins A and B (Medical Benefit Drug Policy)
Defines UnitedHealthcare medical benefit coverage criteria, diagnosis-specific requirements, and coding guidance for botulinum toxin products (types A and B) for applicable commercial and Medicare reviews.
Added language indicating Daxxify is typically excluded from coverage and coverage reviews may be in place if required by law or the benefit plan.
Added reference link to the Medical Benefit Therapeutic Equivalent Medications - Excluded Drugs Coverage Rationale.
Myobloc-specific criteria added for cervical dystonia, detrusor overactivity, sialorrhea, and spasticity including requirement for prior failure/contraindication/intolerance to listed alternatives and authorization durations.
Revised proven indications list for Botox, Dysport, Myobloc, and Xeomin replaced a long enumerated list of etiologies for spasticity with the single term 'spasticity'.
Revised list of unproven and not medically necessary indications; removed pelvic floor spasticity and stiff-person syndrome from that list.
Added CMS section to Supporting Information.
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.