MedicaidPrior AuthMedium impact
Dysport® (abobotulinumtoxinA) (Revised)
Humana·OH · Neurology, PM&R (Physical Medicine & Rehab), Pain Management·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has updated their prior authorization policy for Dysport® (abobotulinumtoxinA) injections, effective January 1, 2026. The policy requires prior authorization for three specific indications: cervical dystonia (ages 18+), lower limb spasticity (ages 2+), and upper limb spasticity (ages 2+), with extensive exclusions for cosmetic and other non-covered uses.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflow for Dysport injections for Ohio Medicaid patients. Ensure prior auth is obtained for cervical dystonia (18+ years), lower/upper limb spasticity (2+ years). Update encounter forms to verify patient age requirements and exclude cosmetic indications (wrinkles, frown lines, etc.) and non-covered conditions (migraines, TMJ, chronic pain). Claims without prior authorization will be denied.