Interactive Drug Benefit List
DIN/NPN/PIN 01981501 BOTOX (100 UNIT/VIAL) 100 UNIT INJECTION ONABOTULINUMTOXINA
920000 MISCELLANEOUS THERAPEUTIC AGENTS
929200 OTHER MISCELLANEOUS THERAPEUTIC AGENTS
Date Listed/Coverage Update: 09-Oct-1992
Unit Price: 3.7485
LCA Price: N/A
MAC Price:

N/A

Unit of Issue: Unit
Manufacturer: ABBVIE CORPORATION (ABV)
ATC: M03AX01
1
Interchangeable Products: No

Coverage Status: REGULAR BENEFIT
Applies to Clients of: Non-Group Coverage (Group 1)
Coverage for Seniors (Group 66)
Palliative Coverage (Group 20514, Please note your client may have Group 1 or Group 66 coverage)
Child and Family Services (Group 20403)
Alberta Child Health Benefit (Group 20400)
Children and Youth Services (Group 19824)
Income Support (Group 19823)
Alberta Human Services (AISH) (Group 19823)
Alberta Adult Health Benefit (AAHB) (Group 23609)

Special Authorization Request Form:

N/A

N/A

Review Status / Past Decisions

Indication Reviewing
Body
Submission
Completion
Date
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
Review
Status
MIGRAINE Common Drug Review 2018/11/16 2019/10/17 View CDR - List with clinical criteria and/or conditions
BLADDER, OVERACTIVE Common Drug Review 2013/12/02 2015/04/01 No Change in Benefit Status
BLADDER, OVERACTIVE Common Drug Review 2013/12/02 2014/11/12 View CDR - List with clinical criteria and/or conditions
MIGRAINE Common Drug Review 2013/08/22 2014/05/28 View CDR - Do not list
NEUROGENIC DETRUSOR OVERACTIVITY Common Drug Review 2012/02/07 2012/07/19 View CDR - List with criteria/condition
Indication MIGRAINE
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2018/11/16
CDR
Recommendation
Date
2019/10/17
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with clinical criteria and/or conditions
Indication BLADDER, OVERACTIVE
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2013/12/02
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2015/04/01
CDR
Recommendation
Review
Status
No Change in Benefit Status
Indication BLADDER, OVERACTIVE
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2013/12/02
CDR
Recommendation
Date
2014/11/12
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with clinical criteria and/or conditions
Indication MIGRAINE
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2013/08/22
CDR
Recommendation
Date
2014/05/28
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - Do not list
Indication NEUROGENIC DETRUSOR OVERACTIVITY
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2012/02/07
CDR
Recommendation
Date
2012/07/19
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with criteria/condition
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Last Updated:
NOTICE:
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.