Nationally, 80% of commercially insured patients have access to QBREXZA for as little as $35 with the QBREXZA Copay Card1*

DermiraConnect is an access support program for patients on QBREXZA

DermiraConnect is a patient services program made simple. This self-guided program provides patients with the support they need when they need it, and helps you keep the focus on managing their treatment.

Confidence in affordability

Patients can manage their out-of-pocket costs with the QBREXZA Copay Card:

Most commercial insurance plans require a Prior Authorization (PA) or Medical Exception (ME)

Completing a PA or ME will allow most patients to get QBREXZA at the lowest out-of-pocket cost.

*With a maximum savings up to $200 per fill, $2500 maximum program limit until December 31, 2019.

One prescription fill = a 30-day supply (30 pouches).

Depending on eligibility and status of coverage. See Terms and Conditions.

§The QBREXZA™ Copay Card is valid ONLY for patients with commercial (private or non-governmental) insurance. 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. Patients who become enrolled in such Government Programs during their enrollment period will no longer be eligible for the Copay Card program. Eligible patients must be residents of the United States, excluding territories, and the patient, or the patient’s parent or guardian, must be 18 years or older to receive Copay Card program assistance.


For questions regarding setup, claim transmission, patient eligibility, or other issues, call LoyaltyScript® for QBREXZA program at 1-877-DERMIRA Monday-Friday, 8 am-8 pm ET.


Dermira, Inc., reserves the right to rescind, revoke, or amend this offer at any time.

Confidence in fulfillment
Coverage Check

Help your patients take control of understanding their insurance coverage for QBREXZA. To conduct a coverage check, there are a few simple questions for you or your patients to answer at DermiraConnect.com. You can also check your patient’s insurance coverage by calling a DermiraConnect support specialist at 1-877-DERMIRA (1-877-337-6472).

Help your patients learn more about their insurance coverage for QBREXZA.

Information to assist with prior authorizations

E-prescribe your patient's QBREXZA prescription today
  • You can e-prescribe QBREXZA to any pharmacy through your e-prescribing system
Prior authorization assistance
Health plans commonly require the following criteria to be met prior to providing coverage for QBREXZA to ensure use in the appropriate patient population:
  • Patient is 9 years of age or older
  • Diagnosis of primary axillary hyperhidrosis: ICD-10 Code L74.510
  • Trial of prescription-strength antiperspirant (eg, Drysol) or clinical-strength over-the-counter (OTC) antiperspirant and rationale for failure/discontinuation
  • Physician attestation to significant impairment of the patient’s participation in daily activities
    Refer to DermiraConnect.com/HCP for prior authorization resources

Confidence in adherence support
  • DermiraConnect can help your patients stay on QBREXZA and get the most out of their therapy by offering:
    • Refill reminders and links to patient education
    • Live DermiraConnect support specialists available by web chat or by phone
Log in to CoverMyMeds.com to initiate an electronic PA or ME request, for quick coverage determination.
Chat online with a DermiraConnect support specialist here
or call us at 1-877-DERMIRA
(1-877-337-6472)
(Monday to Friday, 8 am-8 pm ET)

Reference:

  1. Data on file. Dermira, Inc. Menlo Park, CA.
INDICATION

QBREXZA is an anticholinergic indicated for topical treatment of primary axillary hyperhidrosis in adult and pediatric patients 9 years of age and older.

IMPORTANT SAFETY INFORMATION

Contraindications: QBREXZA is contraindicated in patients with medical conditions that can be exacerbated by the anticholinergic effect of QBREXZA (e.g., glaucoma, paralytic ileus, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, myasthenia gravis, Sjogren’s syndrome).

WARNINGS AND PRECAUTIONS

Worsening of Urinary Retention: QBREXZA should be used with caution in patients with a history or presence of documented urinary retention. Prescribers and patients should be alert for signs and symptoms of urinary retention (e.g., difficulty passing urine, distended bladder), especially in patients with prostatic hypertrophy or bladder-neck obstruction. Instruct patients to discontinue use immediately and consult a physician should any of these signs or symptoms develop. Patients with a history of urinary retention were not included in the clinical studies.

Control of Body Temperature: In the presence of high ambient temperature, heat illness (hyperpyrexia and heat stroke due to decreased sweating) can occur with the use of anticholinergic drugs such as QBREXZA. Advise patients using QBREXZA to watch for generalized lack of sweating when in hot or very warm environmental temperatures and to avoid use if not sweating under these conditions.

Operating Machinery or an Automobile: Transient blurred vision may occur with use of QBREXZA. If blurred vision occurs, the patient should discontinue use until symptoms resolve. Patients should be warned not to engage in activities that require clear vision such as operating a motor vehicle or other machinery, or performing hazardous work until the symptoms have resolved.

ADVERSE REACTIONS

The most common adverse reactions seen in ≥2% of subjects treated with QBREXZA were dry mouth (24.2%), mydriasis (6.8%), oropharyngeal pain (5.7%), headache (5.0%), urinary hesitation (3.5%), vision blurred (3.5%), nasal dryness (2.6%), dry throat (2.6%), dry eye (2.4%), dry skin (2.2%) and constipation (2.0%). Local skin reactions, including erythema (17.0%), burning/stinging (14.1%) and pruritus (8.1%) were also common.

DRUG INTERACTIONS

Anticholinergics: Coadministration of QBREXZA with anticholinergic medications may result in additive interaction leading to an increase in anticholinergic adverse effects. Avoid coadministration of QBREXZA with other anticholinergic-containing drugs.

INSTRUCTIONS FOR ADMINISTERING QBREXZA

Instruct patients to use one cloth to apply QBREXZA to both axillae by wiping the cloth across one underarm, ONE TIME. Using the same cloth, apply the medication to the other underarm, ONE TIME. Inform patients that QBREXZA can cause temporary dilation of the pupils and blurred vision if it comes in contact with the eyes.

Instruct patients to wash their hands with soap and water immediately after discarding the used cloth.

USE IN SPECIFIC POPULATIONS

Pregnancy: There are no available data on QBREXZA use in pregnant women to inform a drug-associated risk for adverse developmental outcomes.

Lactation: There are no data on the presence of glycopyrrolate or its metabolites in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for QBREXZA and any potential adverse effects on the breastfed infant from QBREXZA or from the underlying maternal condition.

Renal Impairment: The elimination of glycopyrronium is severely impaired in patients with renal failure.

Please see Full Prescribing Information.