Medicare AdvantagePrior AuthMedium impact
Qbrexza® (glycopyrronium) Cloth (Revised)
Humana·Dermatology, Pharmacy·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jul 23, 2026
Summary
Humana Medicare Advantage has implemented a prior authorization policy for Qbrexza® (glycopyrronium) cloth for primary axillary hyperhidrosis. Billing teams must obtain prior authorization before dispensing this medication. Coverage requires patients to meet three criteria: diagnosis of primary axillary hyperhidrosis for at least 6 months, HDSS rating of 3 or 4, and documented failure or intolerance to conventional treatments.
Action Required
By July 23, 2025: Billing and pharmacy teams must implement prior authorization process for all Qbrexza® (glycopyrronium) cloth claims for Medicare Advantage members. Before dispensing, verify patient meets all three criteria: (1) primary axillary hyperhidrosis diagnosis ≥6 months, (2) HDSS score of 3 or 4, (3) prior treatment failure or contraindication to at least one conventional treatment (e.g., aluminum chloride 20% antiperspirant, oral oxybutynin). Submit prior authorization requests through Humana's PAL system at www.humana.com/PAL. Update pharmacy billing software and workflow to require prior auth approval before processing claims. Train pharmacy and billing staff on the three approval criteria. Without prior authorization approval, claims will be denied.