Qbrexza® Affordability Assistance

As of late 2018, the FDA-approved, topical anticholinergic wipe Qbrexza® should be widely available in the U.S. for use in the treatment of axillary hyperhidrosis.

Patients with a prescription for Qbrexza® should be able to get that prescription filled at local pharmacies including CVS and Walgreens stores, at pharmacies contained within larger retail outlets (like Walmart), or by mail order.

In an effort to ensure that many axillary hyperhidrosis patients can access Qbrexza®, the makers of the treatment offer a savings and support program called DermiraConnect.

Healthcare providers can visit DermiraConnect to:

  • Receive CoverMyMeds prior authorization support
  • Perform electronic benefits checks for patients
  • Access a prior authorization checklist
  • Web chat with a service representative (available from 8am-8pm ET)
  • Download forms, including: Sample Letter of Medical Necessity and Sample Letter of Appeal
  • E-prescribe Qbrexza.

In addition, DermiraConnect helps to make Qbrexza® affordable through its Qbrexza® Copay Card, a single savings card that patients* can receive three different ways:

  • From you, their healthcare provider
  • By downloading it from DermiraConnect
  • By calling DermiraConnect at 1-877-DERMIRA (1-877-337-6472).

Once a patient has received a card, he or she can activate it by:

  • Visiting DermiraConnect
  • Calling DermiraConnect at 1-877-DERMIRA (1-877-337-6472)
  • Showing the card, a smartphone photograph of the card, or a “digital wallet” version of the card to the pharmacist.

Depending on individual healthcare coverage (commercially insured, under-insured, or un-insured), the Qbrexza® Copay Card can:

  • Help to lower copay amounts for insured patients: Commercially insured patients should pay as little as $35 per prescription fill (for a 1-month supply of Qbrexza®) at the pharmacy. Some patients may pay less than $35, depending on their insurance. (With a maximum savings up to $200 per fill, $2500 maximum program limit until 12/31/19.)
  • Help make out-of-pocket costs more affordable for un/under-insured patients: Un/under-insured patients should pay no more than $70 per prescription fill (for a 1-month supply) at the pharmacy.

Hyperhidrosis patients can visit DermiraConnect to:

  • Receive and activate a Qbrexza® Copay Card.
  • Perform an electronic benefits check and find out if their insurance covers Qbrexza® and about copay amounts.
  • Web chat with a service representative for a benefits check and more (available 8am-8pm ET).
  • Learn about Qbrexza® mail-order options.
  • Find a physician if they don't already have one.

Patients having difficulty getting online or with more questions can call DermiraConnect at 1-877-DERMIRA (1-877-337-6472) to accomplish all of the above. Or, if they prefer email, they can contact Support@DermiraConnect.com.

For non-emergent medical questions or concerns, patients and healthcare providers can contact Dermira Medical Information at (877)337-5553 or DermiraMedInfo@ashfieldhealthcare.com. The Dermira Medical Information lines may be used to report adverse events or side effects or to ask questions about safety, use, disposal, or dosing on a non emergent basis.

*Please note that the Qbrexza® Copay Card cannot be used for patients in Puerto Rico. Patients enrolled in Medicare, Medicaid, Medigap, TRICARE, the Department of Veterans Affairs healthcare program, or any other federal or state government-funded healthcare program ("Government Programs") are not eligible. Eligible patients must be residents of the United States, and the patient, or the patient's parent or guardian, must be 18 years or older to receive Qbrexza® Copay Card assistance.

ICD-10 Codes:

L74.5 - Focal Hyperhidrosis (L74.5 and L74.51 should not – however - be used for reimbursement purposes as there are multiple more specific codes)
L74.51 - Primary Focal Hyperhidrosis
L74.510 -  Primary Focal Hyperhidrosis, Axilla
L74.511 -  Primary Focal Hyperhidrosis, Face
L74.512 – Primary Focal Hyperhidrosis, Palms
L74.513 – Primary Focal Hyperhidrosis, Soles
L74.519 – Primary Focal Hyperhidrosis, Unspecified

L74.52 - Secondary Focal Hyperhidrosis
L74.8 - Other Eccrine Sweat Disorders
L74.9 - Eccrine Sweat Disorder Unspecified

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