11Entitlement to botulinum toxin pharmaceutical benefits for treatment of moderate to severe spasticity of the upper limbs in adults following a stroke

11 Entitlement to botulinum toxin pharmaceutical benefits for treatment of moderate to severe spasticity of the upper limbs in adults following a stroke

(1) This section applies to eligible patients receiving treatment for moderate to severe spasticity of the upper limbs in adults following a stroke: (a) as second line therapy when standard management has failed; or (b) as an adjunct to physical therapy. (2) The maximum number of treatment periods of botulinum toxin pharmacecutical benefits a person mentioned in subsection (1) is eligible to receive is 4 (total Botulinum Toxin Type A Purified Neurotoxin Complex, Clostridium Botulinum Type A Toxin-Haemagglutinin Complex and IncobotulinumtoxinA) per upper limb per lifetime. (3) A person mentioned in subsection (1) is not eligible to receive a botulinum toxin pharmaceutical benefit under this Special Arrangement, for treatment to an upper limb, if the person has previously received the maximum number of treatment periods of botulinum toxin pharmaceutical benefits mentioned in subsection (2) to the same upper limb. (4) A person mentioned in subsection (1) who has been diagnosed with a stroke is not eligible to receive a botulinum toxin pharmaceutical benefit under this Special Arrangement unless: (a) the person does not have established severe contracture; and (b) at least 3 months have elapsed since the person was diagnosed with the stroke. (5) A person mentioned in subsection (1) is not eligible to receive a botulinum toxin pharmaceutical benefit under this Special Arrangement if: (a) after 2 treatment periods with botulinum toxin pharmaceutical benefit, (total Botulinum Toxin Type A Purified Neurotoxin Complex, Clostridium Botulinum Type A Toxin-Haemagglutinin Complex and IncobotulinumtoxinA) per upper limb the person has not responded to the treatment; or (b) the person demonstrates: (i) established severe contracture; or (ii) a known sensitivity to any of the following drugs: (A) Botulinum Toxin Type A Purified Neurotoxin Complex; (B) Clostridium Botulinum Type A Toxin‑Haemagglutinin Complex; (C) IncobotulinumtoxinA (6) However, a person to whom subparagraph (4)(b)(ii) applies is eligible to receive a botulinum toxin pharmaceutical benefit under this Special Arrangement if an eligible medical practitioner considers that it is appropriate to treat the patient with a botulinum toxin pharmaceutical benefit, despite the known sensitivity. (7) A person to whom subparagraph 11(5)(a) applies is considered to have not responded to the treatment if the person has not had a decrease in spasticity rating of greater than 1, using the modified Ashworth scale (MAS), in at least one joint.