Cost of hormones?

[iKate]

I pay $25 at CVS for a 90 day (180) pills supply of spiro. I have no insurance but they have codes they can use. I get 90 days of estradiol for about $13. I'm NOT on the lowest dose of E. It definitely pays to ask.

That's true. There are also discount cards.

[rachel89]

I thought the cost of HRT was a lot more expensive, like over $100 a month.

[iKate]

I called my local walmart (I had to call for a refill of one of mine anyway) and without insurance it's $27.38 for 30 day and $76.90 for 90 day. This is for my dose. Most people are prescribed twice that, so simply double the price since this is the largest dosage they carry.

Now if your doctor wants to save you some money, I am guessing they can just prescribe 4x the smaller pills as they are on the generic $4 list. But if you have insurance it is usually covered as blood pressure medication, as I had mentioned previously.

This pricing is without insurance. There is no sales tax in NJ on prescription drugs, so the price may be slightly different in your state.

So it's not on the $4 list but it's not horribly expensive either.

[iKate]

I thought the cost of HRT was a lot more expensive, like over $100 a month.

It can be.

Estradiol from Walgreens was $40+ for me when I got my first scrip filled. Silly me just chose the pharmacy closest to work. Then I discovered the Wal-Mart $4 list.

Some of these pharmacies really inflate the cost. For example, Rite-Aid wanted to charge me $80 for metformin (diabetes medication). Walgreen's had it for $40. Wal-Mart had it for $4 without insurance and my insurance has a mail order pharmacy that will charge me only $2. From what I understand even with the $4 prescriptions they aren't losing money.

So it pays to shop around.

Also, the prices you see at online pharmacies are often more than the list price for generics at the US pharmacies because they (online pharma) often sell the name brand and not the generic. Just on cost alone if you can see a doctor and get a prescription there is no reason to be ordering online. Of course if you can't, then you might not be left with much of a choice.

[taylorhbic]

Well i know that my insurance (blue advantage silver) wont cover hrt. they said this stuff is cosmetic, but would there be a way around that? i dont mind paying 4 dollars for estro, but i think spiro is whats expensive.

[iKate]

Well i know that my insurance (blue advantage silver) wont cover hrt. they said this stuff is cosmetic, but would there be a way around that? i dont mind paying 4 dollars for estro, but i think spiro is whats expensive.

Yes. Spiro is covered as blood pressure medication by most insurances.

[taylorhbic]

Does anyone think my blood work will be covered by my insurance? all they said was that trans related stuff isnt covered but no where in my blood does it say that.

[Mariah]

Always best to ask them directly. Do you have access to what is included in your plan. It may say what is covered in regards to what. Hugs
Mariah

[taylorhbic]

The problem is that the doc im gonna go see denied the out of network refferal like 5 times even though my insurance company said they couldnt do that, i called my insurance back and they said that they can. So i guess it depends who i ask which is why its taken so long for me to do all this. I need too ask if they will cover bloodwork even though im seeing her out of pocket. I hope this works out ive been trying to do this a long time

[akegia]

The problem is that the doc im gonna go see denied the out of network refferal like 5 times even though my insurance company said they couldnt do that, i called my insurance back and they said that they can. So i guess it depends who i ask which is why its taken so long for me to do all this. I need too ask if they will cover bloodwork even though im seeing her out of pocket. I hope this works out ive been trying to do this a long time

I went to Dr. Hammel for almost 5 months. He doesn't accept any Insurance for Transgender patients that I know of. As he said that most insurance deny it anyways.

I just did all my bloodwork out of pocket, till I moved to my current Endo who fully accepts my insurance(Cigna)

[iKate]

You can get it covered by insurance if you do it right. Get a doctor who does primary care along with hormones and they can bill the insurance for a primary care visit and not any sort of trans care. The exclusions are stupid because they run the same tests anyway except for the hormone levels and even so as a genetic male testosterone test will be covered. Insurance usually does not care and you aren't gaming the system because the whole purpose of the doctor visit is to assess your general health anyway. Prescribing the hormones is just a small part of it.

All of my visits are covered, minus the usual $15 copay. Once they do the billing codes correct insurance does pay without complaint.

[iKate]

Btw for Walmart you can view the $4 list from the app

[iKate]

The problem is that the doc im gonna go see denied the out of network refferal like 5 times even though my insurance company said they couldnt do that, i called my insurance back and they said that they can. So i guess it depends who i ask which is why its taken so long for me to do all this. I need too ask if they will cover bloodwork even though im seeing her out of pocket. I hope this works out ive been trying to do this a long time

Find another doc unless you're in love with this one.

Worse come to worse save your receipts and file a claim with your insurance to get reimbursed.

[taylorhbic]

i wish i knew exactly how too do this. I called my insurance company earlier and they said that i would have to pay out of pocket for blood word even if the refferal was ever approved.

[AshleyP]

If you're not covered by insurance, you should shop around all services and prescriptions. There is a very wide variation of pricing for prescription medications. Also, the discount cards can provide additional savings. Not intended as a slam, but my experience is that Walgreen's has some of the highest pricing. YMMV

-AshleyP

[iKate]

i wish i knew exactly how too do this. I called my insurance company earlier and they said that i would have to pay out of pocket for blood word even if the refferal was ever approved.

Your doctor just has to use the right billing codes and you find one that does your HRT appointments as a primary care visit (which in reality it should be)

[Cynobyte]

here is an odd one i just came across tonight. i believe it is billing code 45 that signals in the computer for transgender issues.  supposedly items like female hormones are automatically rejected if you are coded as male in the system.  this will automatically fix it or send an alert to someone in the company do they can address it for you. 
i always thought the codes were 3 digits, so it could be the wrong code they quoted in the txt, but all codes are the same in the insurance business im guessing.  i found this code under googling "medicare for transgender"..    good luck and let us know if anyone tries this and how it works;)

[taylorhbic]

im not worried about the cost of hormones at this point, im just worried about blood work. There isnt a doc i can see in network that does hormones meaning i cant have them as a primary.

[taylorhbic]

 Also is it possible to get lab work done elsewhere and have it sent too the doctor?

[Cynobyte]

im not worried about the cost of hormones at this point, im just worried about blood work. There isnt a doc i can see in network that does hormones meaning i cant have them as a primary.

Goto your primary care dr.  Tell them flat out you are on hormones.   Tell them the insurance will not pay for the labs unless thry do it.  Most primary doctors will figure a way to get you in.  Plus, you need to tell your primary if you are on hormones.   Its not their choice, but their duty to help you;)