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Botulinum Toxin - Medical Clinical Policy Bulletins | Aetna

    https://www.aetna.com/cpb/medical/data/100_199/0113.html
    As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. Myobloc …

Medical Clinical Policy Bulletins - Aetna

    https://www.aetna.com/health-care-professionals/clinical-policy-bulletins/medical-clinical-policy-bulletins.html
    Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical …

Botox (onabotulinumtoxin A) - Specialty Pharmacy …

    https://www.aetna.com/products/rxnonmedicare/data/2020/Specialty/MISC/Botox.html
    Aetna Non-Medicare Prescription Drug Plan Subject: Botox (onabotulinumtoxin A) Drug Botox® (onabotulinumtoxin A) Policy: Note: The provision of physician samples does …

Botulinum toxin - Pharmacy Clinical Policy Bulletins …

    https://www.aetna.com/products/rxnonmedicare/data/2014/MISC/botulinum_toxin.html
    Under some plans, including plans that use an open or closed formulary, Botox, Dysport, Myobloc, and Xeomin are subject to precertification. If precertification requirements …

Aetna Rx - MEDICARE - Botulinum Toxins …

    https://www.aetna.com/document-library/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68776-3-botulinum-toxins.pdf
    Note: Botox and Myobloc are non-preferred. The preferred products are Dysport and Xeomin. (All fields must be completed and legible for precertification review.) Please …



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