Considering BOTOX® for managing chronic migraine in Canada? The information in this post explores cost considerations, coverage under government drug plans, eligibility criteria, and tips for finding qualified injectors. Whether you’re evaluating treatment options or seeking clarity on accessing BOTOX®, this article aims to provide essential information for individuals considering this therapy.
What is BOTOX®?
BOTOX® was approved by Health Canada in 2011 to treat chronic migraine and has been available in Canada for over 30 years. It is also used to treat several other medical conditions, including blepharospasm, strabismus, spasticity (including foot spasticity in children with cerebral palsy), overactive bladder, cervical dystonia, excessive underarm sweating, and wrinkles. BOTOX® is a protein, a purified botulinum toxin called Onabotulinum toxin A.
How much does BOTOX® cost?
The official dose of BOTOX® used for chronic migraine varies between 155 and 195 units. The cost of a BOTOX® vial varies, in addition to pharmacy mark-ups and dispensing fees. It is important to discuss the cost with your physician, as they can provide detailed information and help navigate coverage options.
Most private plans and some public plans will cover all or part of the cost of BOTOX®. Often, the prescribing physician will have to fill out a form to confirm that other preventive medications have been tried without success.
Is BOTOX® covered by government drug plans?
BOTOX® for the treatment of chronic migraine is currently covered under the Alberta government drug plan and it may be covered under the Ontario and Quebec government drug plans if specific criteria are met.
- For Ontario government criteria, please see this document, and for information on applying, please go here.
- For the Quebec government drug plan, a patient d’exception form must be completed and submitted. This form can be accessed here.
In 2019, CADTH changed its recommendation regarding coverage of BOTOX® by public drug insurers in Canada. Prior to 2019, the recommendation was not to cover, which made access difficult for those covered by public systems. Now, coverage is recommended if specific criteria are met.
In 2019, INESSS, Quebec’s equivalent of CADTH, recommended the coverage of BOTOX®. Before 2011, BOTOX® had been classified as a “Patient d’exception” medication, requiring physicians to complete forms. INESSS re-evaluated the data, including new research and safety information that emerged since 2011, and issued a recommendation to upgrade BOTOX® to a “Médicaments d’exception,” which should make access easier.
These two recommendations are improvements in access to BOTOX® therapy for chronic migraine in Canada. Migraine Canada™ and Migraine Quebec contributed to these processes by submitting reports that included patient input on the impact of migraine. In British Columbia, Pharmacare BC is currently reviewing BOTOX®. Migraine Canada™ has also provided input for this process.
What are the criteria for my insurance to cover BOTOX®?
Different insurance companies (public and private) have different criteria, but these are frequently seen:
- A diagnosis of Chronic Migraine
- Previous trial and failure or side effects with 1 or more migraine preventive medications
Some companies will require proof of effectiveness, like a 30% or 50% response in frequency, or improvement in some quality-of-life scales (for example, the HIT-6).
How can I find a competent injector?
BOTOX® injectors may include neurologists, pain specialists, headache specialists, anesthesiologists, family physicians, physiatrists, and other medical professionals experienced in treating migraine. Some injectors might provide injections but not global management of migraine.
My insurance company covers 80% of BOTOX® costs for migraine. Do I have to pay the rest?
The manufacturer that makes BOTOX®, offers a co-pay program to help with the cost of treatment. Through this program, you may be eligible to receive up to 20% coverage towards the cost of each BOTOX® treatment. Access to the program is managed by healthcare providers who prescribe BOTOX®. Ask your healthcare provider to learn more.
Should I pay injection fees to the physician or the clinic where I receive the injections?
This varies. Access to care in Canada is meant to be equitable between provinces, but there are notable disparities in migraine care, this being one of them. Alberta and Quebec have fee codes (which means your physician is paid to perform the injections), but other provinces don’t. Physicians charge fees directly to patients (which is illegal in Quebec). Fees also vary, with potentially higher fees if injections are administered by a cosmetic physician.
Can I combine BOTOX® and CGRP antibodies? My insurance company refuses to cover both and my physician told me I have to choose one.
Medically, CGRP monoclonal antibodies (MABs) and Botox treatments could be combined. There are reports that this combination might be effective for some people with chronic migraine. For more information, see our post on the BOTOX®/CGRP MAB combination.
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