MedicaidPrior AuthMedium impact
Myobloc® (rimabotulinumtoxinB) (Revised)
Humana·SC · Neurology, Pain Management, PM&R (Physical Medicine & Rehab)·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina updated their prior authorization policy for Myobloc (rimabotulinumtoxinB) injections for cervical dystonia and chronic sialorrhea. Patients must now try and fail Dysport/Xeomin (for cervical dystonia) or Xeomin (for chronic sialorrhea) before Myobloc will be approved, and extensive exclusions apply for non-covered indications including cosmetic uses.
Action Required
Immediately: Billing team must verify prior authorization requirements for all Myobloc injections for South Carolina Medicaid patients. Ensure documentation shows previous treatment, intolerance, or contraindication to Dysport/Xeomin for cervical dystonia patients or Xeomin for chronic sialorrhea patients. Update prior auth request protocols to include this step-therapy requirement. Claims will be denied without proper prior authorization.