MedicaidPrior AuthMedium impact
Myobloc® (rimabotulinumtoxinB) (New)
Humana·OH · Neurology, Pain Management, PM&R (Physical Medicine & Rehab)·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Myobloc® (rimabotulinumtoxinB) injections effective January 1, 2026. Prior authorization is required for cervical dystonia and chronic sialorrhea treatments, with specific criteria including age 18+ and previous treatment failure with other botulinum toxins.
Action Required
Before January 1, 2026: Billing team must update system to require prior authorization for Myobloc® (rimabotulinumtoxinB) injections for Humana Medicaid Ohio members. Train staff to verify prior authorization requirements for cervical dystonia and chronic sialorrhea treatments. Update encounter forms to remind providers of documentation requirements including age verification (18+) and previous treatment history with Dysport/Xeomin. Claims without proper prior authorization will be denied.