Are Botox for Migraines covered by OHIP? The short answer is yes. There are two forms of Botox for migraine, Botox Cosmetic and Botox Dysport. OHIP covers only the treatment for folks over 18 with clinical diagnoses of migraine with aura, migraine without aura, or cluster headaches.
You may find it hard to access the right information on the internet, so we are here to help you in the following article, providing the best and updated information on botox for migraines cost Canada and how to get botox covered by OHIP.
Is Botox for Migraines Covered by Alberta Health Care
How many units of Botox do I need? What is the cost of the procedure?
It is impossible to say without a consultation with one of our staff. We encourage anyone interested and ready for treatment to book an appointment with our office. Initial consult to discuss your medical condition is OHIP covered with a valid health card ($100 without valid card). Actual injections are not covered and a $250 injection fee applies PLUS the cost of the Botox Medication. Please call our office to inquire further as to the process. Often the cost of the Botox itself will be covered in part by third party medical insurance, however, this will not cover the injection fee our office charges.
Who is Botox for?
You must suffer with migraines for 15 days or more per month, with migraines lasting 4 or more hours. This is a Health Canada requirement. Your insurance company may have other requirements for coverage of the Botox Medication. This will vary and is ultimately your responsibility to verify. We make no guarantees as we do not directly bill or deal with your insurance company other than providing any medical information that is needed.
BOTOX® has been available in Canada for more than 30 years and was given the all-clear by Health Canada in 2011 to treat chronic migraines. Blepharospasm, strabismus, spasticity (including spasticity of the foot in children with cerebral palsy), overactive bladder, cervical dystonia, excessive underarm sweating, and wrinkles are among the numerous medical issues it is used to treat. Onabotulinum toxin A, also known as BOTOX®, is a refined form of the botulinum toxin.
To learn more about the workings and efficiency of BOTOX® (See this post)
read more about the dangers and adverse effects of BOTOX® (See this post)
What is the price of BOTOX®?
The recommended BOTOX® dosage for chronic migraines ranges from 155 to 195 units. A 200 unit BOTOX® vial now costs $714 (May 2020), plus the pharmacy’s markup and the dispensing fee.
All or part of the cost of BOTOX® will be covered by the majority of private insurance and certain public ones.
The prescribing physician will frequently need to complete a paperwork to attest that other preventive drugs have been tried and failed.
Do government medication programs cover BOTOX®?
The Alberta government drug plan presently covers BOTOX® for the treatment of chronic migraines, and Ontario and Quebec government drug plans may follow suit if certain conditions are satisfied. (For details on applying and Ontario government requirements, please see this document.) A patient d’exception form must be filled out and submitted for the Quebec government drug plan. You may access this form here.
In 2019, CADTH (https://www.cadth.ca/) revised their advice for public drug insurers to cover BOTOX®. Prior to 2019, it was advised against covering, which made it challenging for Canadians with public health insurance to get access. Now, if certain requirements are met, it is advised to cover. For more information, go here.
The Quebec version of CADTH, INESSS, likewise recommended that BOTOX® be covered in 2019. BOTOX® has been a “Patient of Exception” drug since 2011 and paperwork must be completed by doctors. INESSS revised the information, taking into account new findings and safety information since 2011, and recommended that BOTOX® be upgraded to a “Medication of Exception,” which should make access simpler.
Frequently Asked Questions About Medical Botox Injections
What Can I Expect the Day of a Medical Botox® Injection?
Doctors give medical Botox® by injection into the skin or muscles. It’s usually an office procedure. The number of injections varies for each condition and person. The needles for a medical Botox® injection are very thin so there is only mild discomfort for most people. The procedure can take up to 20 minutes and you go home the same day.
What Are the Risks of a Medical Botox® Injection?
Some common side effects of medical Botox® include dry mouth, headache, neck pain, tiredness, and pain at the injection site. There are also some uncommon, but serious side effects with medical Botox®. Call your doctor or seek medical help if you have weakness all over, loss of bladder control, vision problems or changes, or problems breathing, swallowing or speaking. You should also seek help for signs of an allergic reaction, such as itching, wheezing, dizziness or swelling.
What Precautions Should I Take While Using Medical Botox®?
Most people don’t have serious side effects with medical Botox®. But there have been reports of muscle weakness and vision problems within a few hours or weeks of an injection. If this happens, don’t drive a car, operate machinery, or engage in any risky or dangerous activities. Call your doctor right away.
Does Health Insurance Cover Medical Botox®?
Insurance coverage for medical Botox® varies. Most plans—including Medicare and Medicaid—cover it for FDA-approved indications like migraine. Insurance may or may not cover off-label uses. Call your insurance provider and ask about your coverage. Find out if you need preauthorization or any other paperwork before starting treatment. Talk to your insurance provider and doctor’s office about your costs.
Qualifying for Botox
Botox is approved only for chronic migraine and there’s no evidence to support its use to help treat episodic migraine or tension type headaches.3
In Australia, Botox for chronic migraine is accessible on the pharmaceutical benefits scheme (PBS) from a neurologist trained in Botox use. To qualify, you must meet all of the following criteria:
- An average of 15 or more headache days a month, with at least 8 days of migraine, for at least 6 months before starting treatment.
- Had an inadequate response, intolerance or contraindication to at least 3 prophylactic migraine medications (propranolol, amitriptyline, methysergide, pizotifen, cyproheptadine or topiramate).
- Be managed for medication overuse headache.
- Be aged 18 and over and treated by a neurologist.
To continue to receive Botox on the PBS you must achieve and maintained a 50% or greater reduction from baseline in the number of headache days per month after 2 treatments, 12 weeks apart.(10)
Botox treatment is expensive if you do not qualify for PBS coverage. When covered by the PBS, the government pays the majority of the cost. The amount you pay per treatment can vary significantly and may be a few hundred dollars when including consultation fees. Botox requires seeing a neurologist every three months while treatment is administered.
Botox is a cosmetic treatment that’s also used to treat migraines. It’s injected into specific muscles in the face, and it can help prevent headaches for people who suffer from chronic migraines. Botox isn’t covered by Alberta Health Care. Many patients are frustrated with this situation since they have no other options for treating their condition.
Botox For Migraines Cost Canada
The recommended BOTOX® dosage for chronic migraines ranges from 155 to 195 units. A 200 unit BOTOX® vial now costs $714 (May 2020), plus the pharmacy’s markup and the dispensing fee.
All or part of the cost of BOTOX® will be covered by the majority of private insurance and some public programs.
How To Get Botox Covered By Ohip
About 5,000 prescription drugs are available for search on this page, with the majority of their costs covered by the Ontario Drug Benefit (ODB) program. If you have OHIP coverage and satisfy the criteria listed below and are:
Age 65 or older, qualified for OHIP+, residing in a long-term care facility or a home for special needs, getting specialized home and community care services, and signing up for the Trillium Drug Program