Dosage & Administration Drug label Prior authorization Financial assistance

Xeomin

(botulinum toxin type A)

incobotulinumtoxinA 100 UNT Injection [Xeomin]incobotulinumtoxinA 50 UNT Injection [Xeomin]

Dosage & administration

Chronic Sialorrhea:

* Chronic Sialorrhea in Adults: the recommended total dose is 100 Units per treatment session consisting of 30 Units per parotid gland and 20 Units per submandibular gland, no sooner than every 16 weeks
* Chronic Sialorrhea in Pediatric Patients: the recommended dose is based on body weight administered in a 3:2 dose ratio into the parotid and submandibular glands, respectively, no sooner than every 16 weeks; ultrasound guidance recommended

Upper limb spasticity, cervical dystonia, and blepharospasm: the optimum dose, frequency, and number of injection sites in the treated muscle(s) should be based on severity and prior treatment response in patients previously treated with botulinum toxin; individualize dosing for each patient:

* Upper Limb Spasticity in Adults: the recommended total dose is up to 400 Units, divided among affected muscles
* Upper Limb Spasticity in Pediatric Patients, excluding spasticity caused by cerebral palsy: the recommended total dose is 8 Units/kg (maximum 200 Units) per single upper limb or 16 Units/kg (maximum 400 U) in both upper limbs, divided among affected muscles
* Cervical Dystonia: the recommended initial dose is 120 Units per treatment session
* Blepharospasm: the recommended initial dose is 50 Units (25 Units per eye)

Glabellar Lines: the recommended dose is 20 Units per treatment session, divided into five equal intramuscular injections of 4 Units each (two injections in each corrugator muscle and one injection in the procerus muscle; wait a minimum of three months before retreatment

Reconstituted XEOMIN:

* Is intended for intramuscular or intraglandular injection in the parotid and submandibular glands only
* Use for only one injection session and for only one patient
* Instructions are specific for 50 Unit, 100 Unit, and 200 Unit vials
* Store in a refrigerator (2°C to 8°C) and use within 24 hours

drug label

Xeomin prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Xeomin prior authorization resources

Most recent Xeomin prior authorization forms

View By Payer

Updated: Jun 06, 2023Highmark BCBS Northeastern NY - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)

Updated: Jun 06, 2023Highmark BCBS Western NY - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)

Updated: Jun 05, 2023Highmark BCBS West Virginia - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)

Updated: Jun 05, 2023Highmark BCBS Delaware - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)

Updated: Jun 05, 2023Highmark BCBS Central PA - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)

Updated: Jun 04, 2023Highmark BCBS Western PA - Outpatient Botulinum Toxin Prior Authorization Form (Medical Benefit)

Updated: Jun 04, 2023Blue Cross Blue Shield of Michigan - FEP Xeomin Prior Authorization Form (Medical Benefit)

Updated: May 30, 2023Cigna - Botulinum Prior Authorization Form

Updated: May 29, 2023Blue Cross Blue Shield of Michigan - Botulinum Prior Authorization Form (Medical Benefit)

PDFComplete Letter of Medical Necessity

PDFCoverage Authorization Appeals

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Benefits investigation

PDFBenefit Investigation Form

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Xeomin financial assistance options

Co-pay savings program

commercial only

PDFEnroll in Patient Savings Program

Enroll in Patient Savings Program - For Patients Using Specialty Pharmacy

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Foundation programs

under insured

no insurance

goverment insurance

65+

PDFXeomin Patient Assistance Program Application

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Xeomin patient education

Getting started on Xeomin

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link