My insurance dropped hormones

[BeverlyAnn]

I got a call from my pharmacy today telling me Express Scripts dropped estradiol from their formulary and I have to get prior approval which is rarely granted. 

[Dena]

Look into Silver Script. I haven't used it for that because they are so cheap but some hormones are covered in the formulary.

[Devlyn]

My insurance hasn't paid for any of my tests or meds. I'm on Massachusetts' "You're single and white, you get nothing" plan. 

Hugs, Devlyn

[Hope springs]

Sorry BeverlyAnn. If it makes you feel better my plan has a paragraph on the back of their book that essentially says ' nothing trans related is covered. I hear the GoodRx web site has good deals and some pharmacy chains have deep discounts if you sign up for their annual membership.

[FTMax]

Download the GoodRx app for your phone. You can put in the exact medicine you're looking to get filled, and it will tell you what the cash price is at all of the pharmacies around you so you can choose the cheapest one. They also have coupons for some meds. It was cheaper to use my insurance for my hormones, but cheaper to use the GoodRx coupons for the meds I needed for surgery. Highly recommend checking it out.

[Deborah]

I'm not currently using it but I do have Express Scripts available to me.  I logged in and checked the formulary and both estrace and a generic are available.  Only estrace requires a Dr's letter; the generic does not.

Unless they use different formularies for TRICARE people.


It is better to be hated for what you are than to be loved for what you are not.
André Gide, Autumn Leaves

[josie76]

My insurance has a line that states " coverage for sexual transformation and erectile disfunction are excluded even if medically nessecary " , then way at the bottom it says " except where required by law".

I have yet to test the last line. I expect it to be an issue but I'd be pleasantly surprised if HRT slips through.

[JeanetteLW]

Here in Oregon insurance companies are required by law to provide trans medical services. Since the VA is federal it does not apply to them. The VA does howeve provide pre and post surgical care, HRT and non-surgical medically necessary services including therapy.

[Deborah]

If you do end up paying out of pocket though it's pretty inexpensive at Walmart.  I did that for a year before I figured out my insurance would pay.


It is better to be hated for what you are than to be loved for what you are not.
André Gide, Autumn Leaves

[patrick1967]

I have to second Max on the Good RX. He recommendded it to me and cut my testosterone in half price wise

[BeverlyAnn]

I'm not currently using it but I do have Express Scripts available to me.  I logged in and checked the formulary and both estrace and a generic are available.  Only estrace requires a Dr's letter; the generic does not.

Unless they use different formularies for TRICARE people.

Mine is through the Insurance Trust for Delta Retirees as Medicare Part D so there is no telling.  On a Delta retirees Facebook page a lot of people have been complaining about changes this year.

[AshleyP]

I got a call from my pharmacy today telling me Express Scripts dropped estradiol from their formulary and I have to get prior approval which is rarely granted.

Shop the price around. When buying a 90 supply, I pay a little over $6/month for my estradiol, out of pocket with no insurance. Avoid Walgreen's when paying out out of pocket, imho.

All the best,
--AshleyP