MedicaidPrior AuthHigh impact
Botox® (onabotulinumtoxinA)
Humana·OH · Neurology, Urology, Ophthalmology +5 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana issued a new Medicaid prior authorization policy for Botox (onabotulinumtoxinA) effective January 1, 2026, covering specific medical conditions while explicitly excluding cosmetic uses. The policy requires prior authorization for all Botox injections and includes age restrictions and previous treatment requirements for certain indications.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Botox (onabotulinumtoxinA) claims for Humana Medicaid Ohio members. Update billing system to flag these cases and create workflow to verify medical necessity criteria including age requirements, diagnosis confirmation, and previous treatment history before submission. Train staff on covered indications versus excluded cosmetic uses to prevent claim denials.