Limited coverage drugs – abobotulinumtoxinA

Last updated on October 7, 2022

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	abobotulinumtoxinA
Strength	300 units/vial, 500 units/vial
Form	lyophilized powder for solution for injection

Special Authority criteria	Approval period
For the treatment of cervical dystonia (spasmodic torticollis) in adults.	Initial: 1 year Renewalⁱ: 3 years
For the treatment of focal spasticity.	Initial: 1 year Renewalⁱ: 3 years

Practitioner exemptions

Physical medicine and rehabilitation specialists may be eligible to enter into a Collaborative Prescribing Agreement (CPA). CPAs are provided by invitation only. Special Authority will identify eligible practitioners who treat a high volume of patients that meet PharmaCare criteria for coverage

Special notes

For renewal requests, physicians must provide documentation of the patient’s functional and/or symptomatic improvement, as well as the dosage and injection schedule

Special Authority request form(s)

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5328 - General Special Authority Request (PDF, 656KB)

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Limited coverage drugs – abobotulinumtoxinA

Practitioner exemptions

Special notes

Special Authority request form(s)