CurrentCignaPolicy N/A

Hyperhidrosis - Sofdra Prior Authorization Policy

Cigna coverage policy governing prior authorization and medical necessity criteria for Sofdra topical gel for treatment of primary axillary hyperhidrosis for members of Cigna-administered health plans.

Policy Summary

PayerCigna

PolicyHyperhidrosis - Sofdra Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and, if criteria are met, approve for 1 year.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≥9 yrsminimum patient age for coverage

1 yrapproval duration if criteria met

4 wksminimum trial duration

2026-05-13most recent review date

Coverage Criteria for Sofdra (sofpironium 12.45% topical gel)

FDA-Approved Indication

Covered when ALL of the following are met:

FDA-Approved Indication - Primary Axillary Hyperhidrosis: Approve for 1 year if the patient meets ALL of the following (A, B, C, and D)

A: Patient is ≥ 9 years of age≥ 9 years

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B: Hyperhidrosis is significantly interfering with the ability to perform age-appropriate activities of daily living

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Policy Summary

PayerCigna

PolicyHyperhidrosis - Sofdra Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and, if criteria are met, approve for 1 year.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior Authorization, Step Therapy, and Provider Requirements

Prior Authorization

Prior Authorization Recommended

Prior authorization recommended for prescription benefit coverage of Sofdra (sofpironium 12.45% topical gel). If the criteria below are met, approve for 1 year.

Approvals provided for 1 year when criteria are met.

Step Therapy

Step Therapy — Prescription Aluminum Chloride Topical Antiperspirant Required

Require a trial of a prescription aluminum chloride-containing topical antiperspirant for ≥4 weeks prior to approval, unless the prescriber documents significant intolerance.

Examples: aluminum chloride 20% topical solution (Drysol, generics).
Trial duration: ≥ 4 weeks.

Prior Authorization

Prior Authorization and Approval Duration

When the coverage criteria for the FDA‑approved indication of primary axillary hyperhidrosis are met (age ≥9, condition significantly interferes with activities of daily living, secondary causes excluded, and step-therapy/intolerance criteria met), prior authorization approvals are provided for 1 year.

Approval duration: 1 year when criteria met.

Denial Risk

Billing/Coding Denial Risk

Claims submitted without covered diagnosis or procedure codes, or not accompanied by covered code(s) under the applicable coverage policy, will be denied. Providers must bill using the most appropriate codes as of the submission date.

Ensure billed diagnosis reflects primary axillary hyperhidrosis when seeking coverage for Sofdra.
Use most appropriate codes effective on the date of submission.

Definitions

Primary axillary hyperhidrosis — definition and treatment algorithm context

DefinitionPrimary axillary hyperhidrosis: excessive underarm sweating originating from primary hyperhidrosis (i.e., underarm) — indication for Sofdra

Treatment algorithm contextFirst‑line: topical antiperspirant therapy (aluminum/zirconium salts); Second‑line: topical anticholinergics (Sofdra, Qbrexza) and botulinum toxin A

Drug application limitsSofdra applied once daily at bedtime to clean, dry skin of both axillae (one pump per underarm); use limited to the underarms

Step requirement before useRequire trial of ≥1 prescription aluminum chloride‑containing topical antiperspirant for ≥4 weeks with inadequate efficacy OR documented significant intolerance to such antiperspirant

OpenPayer

Hyperhidrosis - Sofdra Prior Authorization Policy

Coverage Criteria for Sofdra (sofpironium 12.45% topical gel)

Billing & Coding

Prior Authorization, Step Therapy, and Provider Requirements

Background on Sofdra

Definitions