Adult Comprehensive Neurology Team

Thank you for considering UTHealth Houston Neurosciences for your neurological care. Your physician has recommended that you receive an injectable medication as part of your treatment. The information in this document is intended to help explain the process related to insurance verification, payment, and delivery of your medication.

The Patient Is Responsible for the Medication

As the patient, you MUST authorize the shipment of Botox for your doctor to inject. You will receive a call from a specialty pharmacy. Please refer to the information provided by our office to verify phone numbers that may show up on your phone.

Your time is valuable, and we do not want to reschedule your injection. However, if we do not receive confirmation that the medication will arrive one week before your appointment, you will be rescheduled to avoid a wasted appointment.

What Are Botox®, Dysport® and Xeomin®?

Botox (onabotulinumtoxinA), Dysport (abobotulinumtoxinA), and Xeomin (incobotulinumtoxinA) are brand names for botulinum toxin type A, a neurotoxin that blocks messages between muscles and the nerves that control them. In our clinics, they are used for the treatment of headaches, myofascial pain, and movement disorders. The effects of injecting these medications into muscle usually become apparent within 3 weeks after injection and last up to three months (sometimes up to six months). The Federal Food and Drug Administration (FDA) has approved the use of these medications to treat facial dystonias (spasms), strabismus (crossed eyes), and to soften facial rhytids (wrinkles). Extensive clinical experience has also shown substantial benefits for the treatment of headache and a variety of muscle spasm and pain conditions.

Treatment Process

Our office will schedule you for regular injections, and frequency and dosage will be based on your physician’s recommendation. Most patients come in every three to six months for injections, although this timing can vary. Medication will be injected into muscle, and the exact location of injections will depend on your condition and treatment plan. The office visit for your injection should take about 30 to 60 minutes, depending on the number of injections needed.

What to Bring to Your Appointment

In order to make your appointment as efficient as possible, we request you bring the following to your visit:

• Photo ID
• Insurance card(s), including Medicare Part D if applicable
• Prescription benefits card
• Any related medical records

Verifying Benefits

It is important to understand your insurance benefits, as each insurance provider may have different requirements that must be met before treatment may begin. Our team will help you with this process.

Before your first treatment, our office staff will call your insurance provider to confirm that you have active insurance coverage, including benefits for injectable medications, for each of your injection dates. They will find out whether prior authorization is needed for the medication or for your office visit for treatment. We also confirm whether you have specialty pharmacy benefits, and which specialty pharmacy is your insurance provider’s preferred vendor. If they do not have a contracted pharmacy, we will attempt to find a specialty pharmacy that accepts your insurance. If a denial is received, our staff will contact you to discuss other options.

Ordering Your Medication

Specialty pharmacies are an entire class of pharmacies that exist primarily to distribute and dispense specialty drugs. Some health plans require that injectable medications are obtained through this method, while others allow the provider to choose either a specialty pharmacy or use a buy-and-bill approach. Note that our office only orders these medications via specialty pharmacy. Our insurance eligibility and verification staff will contact the specialty pharmacy to submit the order for your medication.

Payment and Delivery of Medication

Once the specialty pharmacy has your order, usually within 24 to 48 hours, they will contact you directly to get your consent. They will also collect your portion of the drug cost prior to shipping the medication to our office. After the specialty pharmacy processes your payment, they will contact our office to schedule a delivery date.

Our insurance eligibility and verification staff will contact you to let you know when we receive your medication—this usually happens within 14 days of your payment to the specialty pharmacy. At this time, we will inform you of any out-of-pocket expenses for your procedure(s).

You will be expected to pay your out-of-pocket expenses for the actual injections at the time of your appointment, which is usually a separate payment from your medication payment. Should you receive an invoice for the medication, please contact your specialty pharmacy.

Your physician will provide you with a treatment plan, including the name of the medication prescribed, your appointment date(s), and the frequency of injections. Should you have any questions or need to schedule an appointment, please call 832-325-7080.

Common Insurance Terms

• Government Plans: insurance providers that are run by the government, including Medicare, Medicaid, Veteran’s Administration and active military, state health insurance exchanges, and others
• Commercial Plans: private insurance providers, including managed care organizations, pharmacy benefit managers, and employers
• Treatment limits: the number of treatments and dosing a patient is eligible to receive every 12 weeks/90 days
• Patient out-of-pocket: amount the patient will have to pay towards the procedure and/or drug
• Deductible: amount the patient pays for health care services before the insurance provider begins to share expenses
• Co-payment: a method of cost-sharing used by insurance providers that is a set amount the patient pays for an encounter, determined by the patient’s type of plan
• Co-insurance: a method of cost-sharing used by insurance providers that requires the patient to pay a percentage of the cost of the encounter