Botox

(botulinum toxin type A)
Botox 100 UNT InjectionBotox 200 UNT Injection

Dosage & administration

drug label

Botox prescribing information

samples

Request Botox samples

Online Sample Form
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prior authorization

Botox prior authorization resources

Most recent Botox prior authorization forms

View By Payer
Verified: Sep 04, 2023Highmark BCBS Northeastern NY - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)
Verified: Sep 04, 2023Highmark BCBS Western NY - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)
Verified: Sep 03, 2023Highmark BCBS West Virginia - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)
Verified: Sep 03, 2023Highmark BCBS Delaware - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)
Verified: Sep 03, 2023Highmark BCBS Central PA - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)
Verified: Sep 02, 2023Highmark BCBS Western PA - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)
Verified: Oct 02, 2023Blue Cross Blue Shield of Michigan - FEP Botox Prior Authorization Form (Medical Benefit)
Verified: Sep 27, 2023Cigna - Botox Prior Authorization Form
Verified: Sep 26, 2023Blue Cross Blue Shield of Michigan - Botulinum Prior Authorization Form (Medical Benefit)
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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information
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financial assistance

Botox financial assistance options

Co-pay savings program

commercial only
Enroll in Patient Savings Program
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patient education

Botox patient education

Getting started on Botox

To share resource; ask patient to:
1.Pull out phone
2.Open camera
3.Scan QR code with camera
4.Tap link

Patient toolkit

BRAND PAGE
About Botox: Chronic Migraine
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Receiving Treatment: Chronic Migraine
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

VIDEO
Patient Stories: Chronic Migraine
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources: Chronic Migraine
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

PDF
Doctor Discussion Guide: Chronic Migraine
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

PDF
Migraine Tracker: Chronic Migraine
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
About Botox: Adult Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Receiving Treatment: Adult Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
Side Effects: Adult Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

VIDEO
Patient Stories: Adult Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

PDF
Patient Brochure: Adult Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources: Adult Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
About Botox: Pediatric Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Receiving Treatment: Pediatric Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources: Pediatric Spasticity
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
About Botox: Cervical Dystonia
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

VIDEO
Patient Stories: Cervical Dystonia
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources: Cervical Dystonia
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
About Botox: Blepharospasm
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources: Blepharospasm
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
About Botox: Overactive Bladder
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources: Overactive Bladder
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Doctor Discussion Guide: Overactive Bladder
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
About Botox: Overactive Bladder Due To Neurologic Condition
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Receiving Treatment: Overactive Bladder Due To Neurologic Condition
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

BRAND PAGE
Side Effects: Overactive Bladder Due To Neurologic Condition
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link