Qbrexza — Highmark
primary axillary hyperhidrosis
Preferred products
- topical aluminum chloride 20% product
Initial criteria
- age ≥ 9 years
- diagnosis of primary axillary hyperhidrosis (ICD-10: L74.510)
- Hyperhidrosis Disease Severity Scale (HDSS) score of 3 or 4
- therapeutic failure, contraindication, or intolerance to at least one plan-preferred topical aluminum chloride 20% product
Reauthorization criteria
- prescriber attests that the member has experienced a reduction in sweat production defined as a HDSS score of 2 or lower
Approval duration
initial: up to 6 months; reauthorization: up to 12 months