Health Net
Qbrexza (glycopyrronium tosylate)
Drugs for the Skin : Drugs for the Skin
  • Step Therapy Applies
  • Primary Axillary Hyperhidrosis:
    Age Requirement: >= 9
    Duration: 1 plan year
    Specialist Required: Yes
    Medical Test Required: No
    Specialist Type(s): Dermatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year
    Policy Contains Verbiage for Botulinum Interchangeability: No
    Documented Diagnosis: Yes

  • Prior Authorization: Primary Axillary Hyperhidrosis:
    Documented Diagnosis: Yes
    Age Requirement: >= 9
    Duration: 1 plan year
    Reauthorization Required: Yes

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