Coverage of Current Therapies in Hyperhidrosis

Shawn Davis, PharmD: Oral anticholinergics are medications that have been on the market for tens of years. The side effect profile of them is something that is not very tolerable. A lot of patients may try to take the medications and use them, but the side effects are too great, and so they don’t use them very often.

Coverage for compounds is difficult because of concern from payers about 3 or 4 years ago. There were compounds that were costing tens of thousands of dollars, so a lot of payers have really cut down on the use of compounds. They can be used in this space, but, again, there are not a lot of data to support their use in hyperhidrosis or, really, in any area of compounding.

OTCs (over-the-counter options)—there is really a benefit set up in how a client, a payer, is going to want to cover an OTC. Some decide that they want to use those because they’re not very expensive. But they do require a physician to actually write a prescription, so that is sometimes difficult to do. A lot of payers would rather just say, “Have the patient pay for it.”

Botulinum toxin, or Botox, is an option that actually works fairly well in this space. The problem is that there are multiple injections. If used for your armpits or hands, it could be very painful. And they don’t last that long. Payers do pay for it because of the indication that’s FDA approved, but, at the same time, I think patients are hesitant to actually have it done.

Botox is probably the only medication that’s truly approved. Most payers that we work with don’t cover OTCs. Oral anticholinergics are generic. They are covered, but they’re not [used] very often. And compounds are more difficult to get. Botox is approved. More on the pharmacy side, it has that capability, but because it’s administered by a physician and because most physicians do it in their office, it’s paid for on the medical side.

This new medication will likely be the first true pharmacy medication that’s going to be on the market.