Medicare AdvantagePrior AuthMedium impact
Myobloc® (rimabotulinumtoxinB) (Revised)
Humana·KY · Neurology, Pain Management·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Myobloc® (rimabotulinumtoxinB) injections for Medicare and Medicaid members in Kentucky. The policy requires specific criteria to be met for cervical dystonia and chronic sialorrhea treatments, with Medicaid patients needing to try other botulinum toxins first.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Myobloc injections for Humana Medicare and Medicaid Kentucky members. Verify patients meet age requirements (18+) and diagnosis criteria. For Medicaid patients, document previous treatment with or contraindications to Dysport/Xeomin (cervical dystonia) or Xeomin (chronic sialorrhea). Update encounter forms to remind providers of prior auth requirements and exclusion criteria.