MedicaidPrior AuthHigh impact
Botox® (onabotulinumtoxinA) (Revised)
Humana·KY · Neurology, Urology, Pain Management +3 more·Medicaid
Effective date
Jul 1, 2025
We identified it
Jun 24, 2026
Summary
Humana's Botox (onabotulinumtoxinA) prior authorization policy has been revised with specific coverage criteria for multiple medical conditions including spasticity, dystonia, chronic migraine, and urinary incontinence. The policy requires step therapy with alternative medications for certain indications and explicitly excludes cosmetic uses.
Action Required
By July 1, 2025: Billing team must update prior authorization requirements for all Botox injections for Humana Kentucky Medicaid patients. Verify patients meet specific age requirements (12+ for blepharospasm, 16+ for cervical dystonia, 5+ for neurogenic detrusor overactivity) and document required step therapy trials with alternative medications before submitting authorization requests. Update encounter forms to include step therapy documentation requirements.