MedicaidPrior AuthMedium impact
Xeomin® (incobotulinumtoxinA) (Revised)
Humana·OH · Neurology, PM&R (Physical Medicine & Rehab), Pediatrics·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid (Ohio) has updated its Xeomin (incobotulinumtoxinA) prior authorization policy effective January 1, 2026, with revisions as of June 24, 2026. The policy clarifies coverage to four approved indications (blepharospasm, cervical dystonia, chronic sialorrhea, and upper limb spasticity in adults and select pediatric patients) while explicitly excluding numerous off-label uses and all cosmetic applications. All Xeomin requests require prior authorization before dispensing.
Action Required
By January 1, 2026: Billing and prior authorization teams must implement the following: (1) Configure billing system to automatically require prior authorization for all Xeomin (incobotulinumtoxinA) claims for Ohio Medicaid members; (2) Update PA submission templates to verify member meets one of four approved indications only (blepharospasm, cervical dystonia, chronic sialorrhea, or upper limb spasticity—excluding pediatric cerebral palsy); (3) Train providers and clinical staff that ALL other indications listed in Exclusion #1 (including migraine, lower urinary dysfunction, TMD, back pain, gastroparesis, and cosmetic uses) will be denied; (4) Flag any requests for pediatric upper limb spasticity to confirm cerebral palsy exclusion does not apply; (5) Verify member age meets minimum requirements (age 2+ for sialorrhea and pediatric spasticity; age 18+ for other indications). Failure to obtain prior authorization will result in claim denials. Contact Humana PAL (www.humana.com/PAL) for provider claim codes if needed.