Migraine Coverage:
OHIP covers your initial assessment if a Family Physician refers you. If you self-refer or dont have a family physician, there is a $100 consultation fee. Most insurance companies will cover Botox™ for migraines 80-100% if you meet the coverage criteria; however, they won’t cover the injection fee of $250 per treatment.
Coverage Criteria:
15 or more headache days a month
At least 8 headache days of the month should be classified as Migraine days
At least 3 months of the year
Failure of at least 2 - 3 oral agents from the approved list
Approved Drug List:
Triptans
Tricyclic Antidepressants
Alpha 2 agonists
Anti-convulsants (ie Topiramate)
Beta Blockers
Calcium Channel Blockers
ARBs (ie Candesartan)
Ergots
Prednisone
Opioids
Gepants
Please note that some insurance companies will ask for proof of headache days, so it’s important to use a headache tracker app like the Migraine Tracker for proof of headaches
Hyperhidrosis Coverage
OHIP covers your initial assessment if a Physician refers you. If you self-refer or dont have a family physician, there is a $100 consultation fee. Insurance companies usually cover Botox for Axillary Hyperhidrosis if you have failed any of the following:
Prescription antiperspirant 20% or 6.25% Aluminum Chloride hexahydrate (Drysol®, Certain Dri®)
Iontophoresis devices (Drionic®, Fischer, or other)
Oral medication (Glycopyrrolate, Ditropan®, or other)
Surgery (local excision of sweat glands, ETS, or other)
TMJ Disorder/Bruxism
Currently, TMJ Disorder/Bruxism is not covered by the majority of Insurance companies. It is suggested that you contact your insurance company to see if this is a condition they will cover but most patients private pay