Diagnosis: Skin Disorder.
Treatment: Pharmacy/Prescription Drug (Botox).

The insurer has denied Pharmacy/Prescription Drug (Botox). The denial is upheld.

The patient is a female with primary focal hyperhidrosis of the axillae. The patient has tried topical solutions, such as Drysol, Certain-Dri, and over the counter antiperspirants. Her condition causes severe anxiety and stress in public and work situations. The patient has received Botox treatment over the past year.

The subject under review is whether the non-formulary Botox will be more effective than the health plan alternatives, such as anticholinergics, beta-blockers, or benzodiazepines.

The plan's determination is upheld.

No, the non-formulary Botox is not more effective than the plan alternatives. The standard treatment for a chronic condition, such as axillary hyperhidrosis [1-3] is a combination of carefully applied topical aluminum chloride and/or glycopyrrolate pads, as well as carefully-dosed oral anticholinergic therapies. The duration of the use of topical Drysol and similar aluminum chloride drugs has not been provided, so treatment failure with these medications is not established. The patient has not failed topical and oral anticholinergics, and other medications such as benzodiazepines. The patient has not conclusively failed these first- and second-line medications, which usually are as effective as Botox for the majority of patients with axillary hyperhidrosis. The formulary alternatives are of similar effectiveness to Botox injections, and in particular may be so for this patient, and if carefully dosed are with no greater adverse effects compared to Botox injections.