Qbrexza (glycopyrronium cloth 2.4% for topical use) — Cigna

Initial criteria

• Patient is age ≥ 9 years; AND
• Hyperhidrosis is significantly interfering with the ability to perform age-appropriate activities of daily living; AND
• The prescriber has excluded secondary causes of hyperhidrosis; AND
• Patient meets ONE of the following (i or ii):
• i. Patient has tried one prescription aluminum chloride-containing topical antiperspirant for at least 4 weeks and experienced inadequate efficacy; OR
• ii. According to the prescriber, the patient has experienced significant intolerance with an aluminum-containing topical antiperspirant.

Approval duration

1 year