Most Insurers Cover Botulinum Toxin for Axillary Hyperhidrosis: Analysis

KEY TAKEAWAYS

• Most private insurers cover botulinum toxin for primary axillary hyperhidrosis following failure of topical or oral agents.

• Average annual coverage is 3.9 treatment sessions.

• High out-of-pocket costs and inconsistent transparency remain as barriers to wider care.

A new cross-sectional study published in the Journal of Drugs in Dermatology finds that while botulinum toxin is broadly covered by private insurers for the treatment of primary axillary hyperhidrosis, access barriers due to high out-of-pocket costs remain.

Researchers analyzed publicly available coverage guidelines from the largest private insurer in each U.S. state. Of the 50 states, 40 insurers had accessible policies; all listed primary axillary hyperhidrosis as a medically necessary indication for botulinum toxin use after failure of topical or oral agents.

Prior authorization was universally required. Coverage included all botulinum toxin type A formulations [onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), and daxibotulinumtoxinA (Daxxify)]. The average number of sessions covered annually was 3.9. The study authors cited treatment frequency, copays, deductibles, and toxin-specific cost variation as significant contributors to patient cost burden. Ten insurers lacked publicly available policies.

“Our results indicate that all private insurers cover botulinum toxin for primary axillary hyperhidrosis after failed treatment with standard topical or oral agents, reinforcing evidence of its safety and efficacy,” the authors wrote. “Increasing patient education on insurance coverage policies and alternative financial assistance programs may aid in reducing the financial burden of disease and improving long-term outcomes.”

Study limitations included the exclusion of smaller insurers and public plans such as Medicaid and Medicare.

Source: Sharifi S, et al. Journal of Drugs in Dermatology. January 2026;25(1):9398