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Public health insurers’ coverage of botulinum toxin treatment costs

Treatments with the neurotoxin botulinum toxin can be covered by public health insurance under certain circumstances. However, this does not usually include aesthetic indications such as anti-wrinkle injections. If, on the other hand, there are medical indications, the treatment can in many cases be covered by the public health insurance. 

Working principle

Botulinum toxin is a neurotoxin that is produced by anaerobic bacteria of the genus Clostridium botulinum in seven different serotypes from A to G. Subtype A is particularly used for numerous therapeutic purposes.  

This toxin acts by inhibiting the transmission of excitation from nerve cells to other cells, especially muscle cells. Through the breakdown of protein complexes, the release of the neurotransmitter acetylcholine is blocked. As a result, the contraction of the muscle becomes weaker or fails completely, causing paralysis of the muscle. The duration of action of the drug is usually about 12 weeks. 

Indications

The indications that are usually covered by public health insurance include the following: 

Neurological diseases

  • Focal spasticity of arms and legs (after stroke)
  • Blepharospasm (eyelid spasm)
  • Spasmus hemifacialis (unilateral spasm of the facial muscles)
  • Cervical dystonia (torticollis)
  • Pointed foot due to infantile cerebral palsy
  • Tension headaches & chronic migraines (more than 15 days per month)

Bladder dysfunction

  • Overactive bladder
  • Urinary incontinence following unsuccessful treatment with anticholinergics
  • Detrusor-sphincter dyssynergia

Skin related disorders

  • Severe primary hyperhidrosis axillaris

Gastrointestinal disorders

  • Achalasia & esophageal spasms
  • Hirschsprung’s disease
  • Anal fissures

Ocular disorders

  • Strabismus

Conclusion

If the compound is used for a purpose not listed in the compound’s technical information, it is necessary to consult with the health insurance provider prior to treatment, as the reimbursement of costs is often individually assessed.

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Bibliography

  1. J. Schantz, E. A. Johnson: Properties and use of botulinum toxin and other microbial neurotoxins in medicine. In: Microbiol Rev.1992;56, S. 80–99.
  2. Deutsche Gesellschaft für Neurologie: Migräne: Bakteriengift hilft chronisch Kranken.Deutsche Gesellschaft für Neurologie, Pressemitteilung September 2009
  3. Kassenärztliche Bundesvereinigung Neue Leistung ab 2018: Botoxbehandlung bei Blasenfunktionsstörung.
  4. Cornelia Neth: Was ist bei der Abgabe von Botox zu beachten? newsletter. deutsche-apotheker-zeitung 2021
  5. Botulinumtoxin-Therapie Universität Würzburg Prof. med. Dr. Jens Volkmann