Western Health Advantage
Qbrexza (glycopyrronium tosylate)
Drugs for the Skin : Drugs for the Skin
  • Step Therapy Applies
  • Prior Authorization: Primary Axillary Hyperhidrosis:
    Documented Diagnosis: Yes
    Age Requirement: >= 9
    Duration: 1 year(s)

  • PA Required
  • Primary Axillary Hyperhidrosis:
    Age Requirement: >= 9
    Duration: 1 year(s)
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Policy Contains Verbiage for Botulinum Interchangeability: No
    Documented Diagnosis: Yes

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