Successful Strategy to Overturn Payor Policy Change on Treatment for Postparalytic Facial Palsy

Clinical Question

What can physicians do to address a payor’s detrimental policy change regarding patient treatment, as demonstrated in a 2021 case impacting patients with postparalytic facial palsy?

Bottom Line

Presentation of strong and consistent data demonstrating the superiority of onabotulinumtoxin A (Botox) over incobotulinumtoxin A (Xeomin) for treatment of postparalytic facial palsy prompted reversal of a payor’s previous detrimental policy change.

Background: Nonflaccid facial palsy (NFFP) develops following facial nerve injuries and after facial nerve repair and grafting. Alongside facial therapy, botulinum neurotoxin A (BoNTA) can give patients with NFFP improved facial symmetry and quality of life. Although there are three available BoNTAs to treat facial paralysis, they are not all the same.

Study design: Commentary

Setting: Department of Otolaryngology–Head and Neck Surgery, University of North Carolina Facial Nerve Center, Chapel Hill, N.C.

Synopsis: Authors describe the actions they took to successfully overturn an insurance provider’s policy change concerning treatments for NFFP. In this change, a major North Carolina insurer mandated that patients with facial nerve disorders must fail treatment with Xeomin before going on to Botox. However, authors explain, data do not support the use of Xeomin before Botox for facial paralysis. They cite a 2018 clinical trial comparing the three clinically available BoNTAs—Botox, Xeomin, and abobotulinumtoxin A (Dysport)—in which Botox was shown to be superior to Xeomin. To overturn the policy, the authors: 1) wrote a white paper with medical references explaining how Botox is a more evidence-based treatment for NFFP and included it with insurance appeals; 2) enlisted the help of state societies to demonstrate a united front on the issue; 3) filed an executive inquiry with the insurance provider; and 4) filed a complaint with North Carolina’s Department of Insurance, prompting a state investigator to contact the insurance company’s legal department. They also recruited patients, local media, and local politicians to join the fight. The authors emphasize the importance of countering “penny-wise and pound-foolish” payor policies with strong and consistent data.

Citation: Miller MQ, Clark JM. Responding to payor policy changes that impact patients with postparalytic facial palsy: chemodenervation with botulinum toxin. Facial Plast Surg Aesthet Med. 2022;24:335-336. doi:10.1089/fpsam.2021.0372.