Is Botulinum Toxin Covered By My Benefit Plan?

What is botulinum toxin?

Over the past 50 years, medical research has focused on using the properties of botulinum toxin to treat conditions such as muscle stiffness or spasms, multiple sclerosis, urinary incontinence, excessive sweating, and migraine headaches. It works by interfering with pain receptors in the body and/or relaxing muscles, which can assist with mobility and bodily function.

The most recognizable brand of botulinum toxin is Botox®, but there are other treatments available in Canada, including Dysport® and Xeomin®.

From a medical perspective, botulinum toxin is a deadly substance that has been refined for specific health conditions and, more recently, as a cosmetic procedure to reduce the appearance of wrinkles and sagging skin associated with aging.

Is botulinum toxin covered by my benefit plan?

ASEBP covers Botox®, Dysport ® and Xeomin® through the special authorization drug process for some diagnosed health conditions, such as migraine headache and multiple sclerosis. It is not covered for any off-label use, dental, or cosmetic procedure, including the treatment of temporomandibular joints (TMJ) disorder.

Products must be used for an approved medical indication by Health Canada and purchased through a licensed pharmacy with a prescription from a licensed health care provider. Products dispensed in a health care provider’s office are not eligible for reimbursement.

Please note that botulinum toxin is eligible for reimbursement through your Health Spending Account if the product is prescribed by a certified medical professional or registered dentist and dispensed by a licensed pharmacist.

To apply for special authorization approval, your health care provider must submit an application on your behalf. Please note that your physician or nurse practitioner has access to these forms.

Is injectable botulinum toxin dangerous?

No. Injectable botulinum toxin is provided in microscopic doses and customized depending on its intended use. Typically, treatment consists of multiple injections into target areas, repeated every three months once the effectiveness wears off.

Injections of botulinum toxin should always be administered by a trained health care provider to ensure safe, effective use.

What about drug interactions with botulinum toxin?

Some products that can interact with botulinum toxin include:

• certain antibiotics (including aminoglycosides such as gentamicin, polymyxin)
• anticoagulants (such as warfarin)
• Alzheimer’s disease drugs (such as galantamine, rivastigmine, tacrine)
• myasthenia gravis drugs (such as ambenonium, pyridostigmine)
• quinidine

It is important to understand the risks and benefits of this therapy, including any interactions with prescription and non-prescription drugs or herbal products. Do not start, stop, or change the dosage of any medicines without your health care provider’s approval.

How ASEBP supports you

Contact a benefit specialist if you have questions about ASEBP’s special authorization process. A decision may take up to 14 business days once submitted by your health care provider. You can check the status of your request in My ASEBP by clicking on Documents–>Drug Special Authorizations.

If you have chronic pain, find helpful resources and explore ASEBP’s Employee and Family Assistance Program (check your ASEBP ID card for eligibility). Group plan members can get four free hours of counselling and health coaching from a variety of licensed professionals each calendar year.

The information provided in this article is for personal use, reference, and education only. ASEBP does not provide medical advice. Before starting any medication or product, you should always consult with your pharmacist, health care provider, or call Alberta Health Link at 811.